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The case was a 68-year-old woman who presented with a complaint of an abdominal mass. She was diagnosed with the retroperitoneal liposarcoma. In the initial surgery, the primary tumor was resected together with the right colon involved. Since the histological type was the dedifferentiated type, imaging tests were performed every 10 weeks. After all there were seven local recurrences and one recurrence of lung metastasis, and each time the tumor relapsed, a combined resection of surrounding organs were repeated. At the time of the eighth recurrence, she requested chemotherapy. But her illness progressed. Five and a half years after the initial surgery, she passed away. The only effective treatment for retroperitoneal liposarcoma is surgical resection, but the prognosis varies depending on the histological type. The dedifferentiated type is a disease that often has a poor prognosis due to repeated local recurrence and inoperability. In this case, we report with a literature review on a case in which we were able to detect a recurrence in a state that was resectable by performing imaging tests at short intervals for dedifferentiated liposarcoma, and we were able to achieve long-term survival through 8 surgeries.

In patients with ER-positive HER2-negative unresectable breast cancer, who are refractory to chemotherapy, surgery may not be performed even after endocrine therapy. CDK4/6 inhibitors have been used as first-line treatment for unresectable breast cancer since their approval in Japan. We investigated the primary treatment of ER-positive HER2-negative inoperable breast cancer and its efficacy in our hospital. 14 patients diagnosed between March 2017 and October 2022 were included. Three patients were treated with endocrine therapy alone(HT), 6 with CDK4/6 inhibitors(all 6 with palbociclib[PAL]), and 5 with chemotherapy(CT). Median age at diagnosis was 83, 74.5, and 67 years, respectively. In the HT group, 2 patients died, 1 patient discontinued due to metastasis. In the PAL group, 2 patients discontinued due to adverse events, 4 patients underwent surgery. All 5 patients in the CT group underwent surgery. In some patients who were refractory to chemotherapy, the combination of CDK4/6 inhibitors reduced tumor size to the extent that surgery was possible, suggesting the effectiveness of this combination as first-line treatment.

Robotic-assisted surgery enables precise manipulations with magnified vision, stereoscopic vision, and forceps with multi-joint functions. It requires unique procedures such as position setting, port placement, roll-in, and docking, which lead to prolonged operation and anesthesia time. Five conditions described below were established at our institution to reduce the time to the initiation of console: (1) changing the patients' position from the flat lithotomy position to the spread legs position; (2) attaching a Hasson cone to hold the umbilical cannula stable; (3) changing the cannula's obturator (inner tube) from blunt to bladeless; (4) fixing the team, and (5) conducting regular docking training. These outcomes were examined in this study. The study included 77 patients who underwent robotic-assisted total hysterectomy for benign uterine disease and stage IA uterine cancer at our individual institution between April 2019 and July 2022. We compared the median time from anesthesia to console initiation between the first half group (cases 1-40) and the second half group (cases 41-77). The former required 91.5 (53-131) minutes, whereas the latter required 59 (37-126) minutes. Appropriate equipment selection and team education can reduce the time to console initiation.

Adenocarcinoma, HPV-independent, mesonephric type (hereafter referred to as "mesonephric carcinoma") arising from the cervix is rare, its treatment has not been established, and its sensitivity to chemotherapy has not been fully investigated. Here we report on a 30-year-old female patient who presented at our hospital with a chief complaint of abnormal genital bleeding. We suspected cervical cancer. Based on examination, biopsy, and imaging, she was diagnosed with stage IIA2 adenocarcinoma of the cervix and was scheduled for surgery. Because she had a SARS-COV-2 infection, she was given two courses of paclitaxel-carboplatin (TC) therapy, based on the then-current surgical risk assessment after SARS-COV-2 infection, with a waiting period of at least 8 weeks. The patient was deemed to have a partial response and was treated with paclitaxel and carboplatin, after which she was deemed to have a partial response and underwent total hysterectomy. A diagnosis of stage IIA2 mesonephric carcinoma, ypT1b2N0M0, was made after histopathologic examination of an excised specimen. The patient was treated with 4 additional courses of TC therapy after surgery, and has had no recurrence in 13 months. We report a first case of response to neoadjuvant chemotherapy with TC regimen in a patient with mesonephric carcinoma of the cervix.

Objectives: Virtual reality (VR) and three-dimensional (3D) images have become increasingly popular. It has been reported that visually induced motion sickness (VIMS) is more frequently caused by viewing these images. We propose a method to control VIMS by controlling visually evoked postural responses (VEPRs) using galvanic vestibular stimulation (GVS). In this study, we focused on the effect of VEPRs on body sway and conducted a transfer function analysis between the GVS and body sway. On the basis of the results of this investigation of the causes of VIMS, countermeasures must be considered., Methods: The experiment involved 15 healthy young adults, comprising six males and nine females, all aged 21 years. The subjects were asked to maintain a Romberg posture while viewing an image that included a large number of randomly positioned moving spheres with their peripheral vision. In addition, body sway during GVS as an external stimulus was measured for 120s for each task., Results: The transfer function analysis of the body sway showed that the influence on the equilibrium function was significantly enhanced not only by the GVS but even more so by viewing the video clips synchronized to the GVS., Conclusions: GVS current signals induced body sway and increased the width of body sway synergistically. It was also suggested that a time delay structure occurred between the GVS current signal and body sway.

A 78-year-old man was diagnosed as HER2-positive unresectable advanced gastric cancer(cT4aN3M1[LYM], Stage Ⅳ). After 2 courses of first-line chemotherapy(S-1 plus oxaliplatin plus trastuzumab), PR was achieved. The treatment could not be continued due to adverse events after 5 courses, thus second-line chemotherapy was conducted. Corresponding to the physical condition. The third-line chemotherapy was also introduced. However, we clinically judged PD because of amount of ascites and chemotherapy was terminated. After that, he has survived for more than 2 years without chemotherapy, and endoscopy and CT showed the disappearance of the tumor, metastatic lymph nodes, and ascites at 41 months after diagnosis. Looking back on the changes in tumor markers, it was possible that he had already achieved CR at the first-line chemotherapy.

A 78-year-old man was diagnosed with lymph node metastasis 2 months after surgery for gastric neuroendocrine carcinoma. He received chemotherapy(CDDP plus CPT-11)and showed partial response(PR)after 3 courses of the regimen. Serum CEA increased 5 months after surgery, thus nab-paclitaxel plus ramucirumab was administered. Although the lymph node kept shrinked after 2 courses of the regimen, the lymph node was detected 12 cm of the size in CT after 5 courses of the regimen. He started to receive nivolumab. The lymph nodes showed PR after 4 courses, and complete response after 6 courses of the regimen for 1 year and 4 months until now.

The study presents the case of a 71-year-old woman who visited a nearby hospital for epigastric pain and weight loss. A CT scan showed a mass in the gallbladder, and the CEA level was high, so she was referred to our hospital for further investigation. Abdominal US, CT, and MRI suggested gallbladder cancer with para-aortic metastasis, and the histological findings on the EUS-FNA confirmed the diagnosis. Since surgical resection was not indicated, chemotherapy was performed(gemcitabine plus cisplatin). After 10 courses of chemotherapy, CT and MRI showed downsizing of para-aortic lymph nodes, and no accumulation of FDG was found on FDG-PET. Confirming the downstaging of cancer, conversion surgery, comprising an extended cholecystectomy and a lymph node resection, was performed. The pathological diagnosis showed no lymph node metastasis. No recurrence was observed after 12 months of surgery. Initially, unresectable gallbladder cancer with para-aortic lymph node metastasis was indicated to be compatible with preoperative chemotherapy and conversion surgery.

A 52-year-old man underwent total gastrectomy for gastric cancer and chemoradiotherapy for thoracic paraaortic lymph node metastasis. He also underwent esophageal stent implantation for stenosis. He was admitted to our hospital with fever and breathing difficulty and was diagnosed with infectious pericarditis. He showed symptoms of shock due to cardiac tamponade. After pericardial drainage, his vital signs improved. When signs of infection are detected in patients with a history of chemoradiotherapy or stent implantation, we should consider infectious pericarditis due to esophageal pericardial fistula and apply immediate drainage of cardiac tamponade.

Purpose: The purpose of this study was to evaluate the accuracy of incident air kerma (K a,r ) and air kerma-area product (P KA ) displayed on over-couch-type X-ray fluoroscopic systems by comparing them with the measured values., Methods: An ionizing chamber was placed at the patient entrance reference point to measure the K a,r . The P KA was calculated by multiplying the K a,r by the irradiation area. These measured values were compared with the displayed values., Results: The differences between measured and displayed K a,r and P KA were less than ±35%, which was the criteria of the Japanese Industrial Standards (JIS). However, the accuracy of the displayed values differed depending on the manufacturer and the device., Conclusion: Although no error exceeding the JIS criteria was observed, it is necessary to understand the characteristics of the X-ray fluoroscopic systems related to displayed dose and to manage the systems by performing dose measurements periodically.

Objectives: These days, developments in graphical technology have resulted in an increase in the chance to view 3D video clips. Visually induced motion sickness (VIMS) has been widely reported as a negative result of viewing these clips. The onset of VIMS is explained by some hypotheses. However, the root causes of VIMS have not been elucidated yet, whereas dizziness and nausea are regarded as symptoms of VIMS. In this study, we focus on the difference in the pattern of body sway among age groups and examine whether the consistency between the background and the viewpoint motion depends on the severity of VIMS., Methods: This experiment was conducted with 116 subjects aged 15-89 years. They peripherally viewed a 3D video clip showing a sphere whose motion was consistent with their viewpoint (VC-I) and another 3D video clip of a sphere whose motion was inconsistent with their viewpoint (VC-II). Statokinesigrams (SKGs) were recorded with their eyes open and with their eyes closed for 60 s. The amount of sway was calculated from the SKGs., Results: Results showed that for all age groups, sway values were significantly higher when viewing the 3D video clip (VC-II) than in the Pre. However, for the elderly, there was no significant difference between the sway values while viewing the VC-I and those in the Pre., Conclusions: Results suggest that VIMS might not occur in the elderly because of the deterioration of their visual function, such as visual acuity and accommodation, with advancing age.

Objectives: Olfactory stimulation elicits various physiological responses. However, few reports exist on the changes in gastric motility during olfactory stimulation in humans. In this regard, we carried out electrogastrography (EGG) to non-invasively measure the gastric myoelectrical activity, which regulates gastric motility. Moreover, subjective sensory evaluation was performed to determine which characteristics of vanilla odor at two different concentrations affect the myoelectrical activity., Methods: The participants consisted of eight healthy young males. EGG and electrocardiography (ECG) recordings were obtained approximately 20 min prior to and during olfactory stimulation. Autonomic nervous system activity was evaluated in terms of heart rate variability (HRV) and mean heart rate (HR) from ECG signals. EGG signals were analyzed by spectral analysis. In addition, the translation error was estimated by the Wayland algorithm. Sensory evaluation was performed using the Visual Analog Scale (VAS)., Results: There were no significant differences in HRV and HR values and results of spectral analyses of EGG signals in all sample presentations. The translation error of EGG signals and the rating of perceived odor intensity significantly increased in a concentration-dependent manner. There was a strong positive correlation between translation error and odor intensity., Conclusions: The correlation found between translation error and odor intensity suggests that the higher the vanilla odor intensity was perceived, the greater the randomness of EGG signals was. Our results suggest that the application of the Wayland algorithm to EGG signals can be used as an objective indicator in odor evaluation.

A 69-year-old man presented to our hospital with chief complaints of epigastral pain and nausea, was diagnosed with intestinal obstruction after gastric surgery. Abdominal CT performed on the admission showed the tumor located on the terminal ileum. On colonoscopy, type 1 cancer was found near the Bauhin valve in the ileum, and suspected primary ileal carcinoma. Laparoscopic ileocecal resection was performed. The pathological diagnosis was moderately differentiated adenocarcinoma, and the pathological stage was T3(SS), N1(3/16), M0, Stage ⅢA. Although superficial surgical site infection was occurred, the patient was discharged 11 days after surgery. He hoped to adopt without adjuvant chemotherapy, so he has been followed as outpatient. Twenty one months since the surgery, there has been no evidence of cancer recurrence.

Dynamic chest radiography (DCR) is a flat-panel detector (FPD) -based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view of FPDs permits real-time observation of motion/kinetic findings on the entire lungs, right and left diaphragm, ribs, and chest wall; heart wall motions; respiratory changes in lung density; and diameter of the intrathoracic trachea. Since the dynamic FPDs had been developed in the early 2000s, we focused on the potential of dynamic FPDs for functional X-ray imaging and have launched a research project for the development of an imaging protocol and digital image-processing techniques for the DCR. The quantitative analysis of motion/kinetic findings is helpful for a better understanding of pulmonary function, because the interpretation of dynamic chest radiographs is challenging and time-consuming for radiologists, pulmonologists, and surgeons. Recent clinical studies have demonstrated the usefulness of DCR combined with the digital image processing techniques for the evaluation of pulmonary function and circulation. Especially, there is a major concern in color-mapping images based on dynamic changes in radiographic lung density, where pulmonary impairments can be detected as color defects, even without the use of contrast media or radioactive medicine. Dynamic chest radiography is now commercially available for the use in general X-ray room and therefore can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. This review article describes the current status and future prospects of DCR, which might bring a paradigm shift in respiratory diagnosis.

Completion pneumonectomy (CP) is the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection and is one of the most invasive operations in the field of general thoracic surgery. Mortality and morbidity rates are higher after CP than standard pneumonectomy. CP is a highly demanding procedure, usually due to major pleural and sometimes pericardial dense adhesions from previous surgery or infection. Intra-pericardial control of the pulmonary artery and veins is recommended to avoid vessel injury. Therefore, this operative intervention should be performed only by experienced thoracic surgeons on carefully selected patients in order to improve postoperative outcomes. Preoperative pulmonary and cardiac functions are decreased by the previous procedure. In addition, the rate of complications is high because of excessive operative invasiveness. Therefore, preoperative assessment, surgical indication, low invasive surgical technique, and good postoperative management are very important elements when CP is performed. On the other hands, CP may be a reasonable option for postoperative lung cancer recurrence or new primaries only in carefully selected patients, in whom the potential oncological benefits overweigh the surgical risk. This article reviews these operative knack and pitfalls.

Background: We investigated the feasibility and efficacy of thoracoscopic segmentectomy using 3-dimensional computed tomography( 3D-CT) and indocyanine-green( ICG) fluorescence navigation., Methods: ICG fluorescence-navigated thoracoscopic segmentectomy was performed in 149 patients during 2013 and 2017. Each patient underwent preoperative evaluation by thin-section enhanced CT, which provided 3-dimensional simulations of vascular and bronchial structures. During the procedure, low-dose ICG( 0.15~0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under near-infrared thoracoscopic guidance, an intersegmental plane was clearly observed as a border between dark target region and bright residual region. The ICG fluorescent line was marked by electrocautery, followed by division of lung parenchyma along the line by endoscopic staples., Results: An intersegmental line was visible in 98% of patients by ICG fluorescence navigation. No ICG-related adverse events occurred. No operative mortality was observed and morbidity rate was 8.7%. The 5-year overall survival rate and the 5-year recurrence free probability of 101 patients with primary lung cancer were 92% and 98%, respectively. Local recurrence at the resected site occurred in no patient with lung cancer and 1 patient with pulmonary metastasis., Conclusion: Thoracoscopic segmentectomy using 3D-CT and ICG fluorescence navigation is a useful therapeutic option.

We analyzed 197 fall incidents in the questionnaire survey about the incident that occurred in Department of Radiology. In the past paper about the patient safety, there is no report that evaluated incident data directly. The purpose of this paper is to analyze the factor of the medical incidents using statistical technique scientifically. In this paper, we do not suggest concrete precaution. At first, we found the number of patients (each gender, modality, generation) in the five facilities of the coworker of one week. We found an incident rate from this patient total number, and we normalized data. As a result, we were able to do each risk evaluation because a risk ratio and relative risk degree was found. And, we were able to identify modality and the generation with the significant difference using the testing for differences in population rate. By our analyses, we revealed the chapter which must strengthen safety management.

We conducted a questionnaire survey (situation, patient factor, environmental factor, operator factor, degree of disability, countermeasure etc.) on cases that occurred up to the present to investigate the actual situation of the medical accidents that occur in the radiological examination department of medical institutions. There were 373 questionnaires collected. Among them, there were 197 cases of falls. In this study, we examined the age of patients who fell, the background of the accident, and factors. As for the accident, 11.7% of accidents with risk impact level 3b or higher occurred including the fatal accident. Of the accidents, 44.2% were foreseeable and 55.8% were unforeseeable. The most accident-prone age was elderly in their 60s to 80s. As the causative factor for the accident, the patient factor was the largest at 63.5%. We can prevent about 30% of the accident by improving the operator factor and the environmental factor which are parts other than patient factor. It is important for us to understand what kind of people tend to fall. Among foreseeable accidents, the causes of patient factors can be reduced.

Purpose: The purpose of this study is to analyze the factors of patient's fall that causes serious injury in the radiological examinations., Methods: We conducted a questionnaire survey on cases of medical accidents occurring in the radiological examination department in medical institutions. The number of responses to the questionnaire surveys was 372. Among them, 197 cases were related to fall. The incident influence classification divided into eight clusters (0, 0H, 1, 2, 3a, 3b, 4, 5) was divided into three clusters (tiny, moderate, serious injury) depending on severity. We analyzed the factors that cause serious injury., Results: In the case of patient's fall, several factors have been found to cause serious injury. The factors were general radiography, standing position, outside working hours., Conclusion: All falls can cause serious injury. To reduce falls, it is important to analyze what kind of patient and in what situation tend to fall, and prevent falls in advance.

Purpose: The purpose of this paper is to analyze the characteristics of incidents related to routes and drains that occur in the radiological examination room for the prevention of these incidents., Methods: We conducted a questionnaire survey on incident cases that occurred in the radiological examination room. There were 373 responses, of which 76 responses were related to routes and drains. The question contents were the number of hospital beds, radiology department of occurrence, time of occurrence, patient's situation, method of visiting, years of experience of the radiological technologists, and countermeasures, and so on. Based on these answers to these questions, we analyzed which factors were involved in the occurrence of the incidents., Results: Incidents related to routes and drains often occur when moving examination table or transferring the patients to the examination table using the slider. On the other hand, the years of experience of the radiological technologists hardly participated in the factor of these incidents. From these answers to questions, 75% of incidents might predictable, and these incidents could be prevented by improvement of human factors accounted for the majority rather than that of physical factors., Conclusion: The number of incidents related to routes and drains may reduce by that all staff involved in the radiological examination recognizing the characteristic of these incidents.

A 69-year-old woman was diagnosed with a germ cell tumor in the anterior mediastinum. Following 3 years follow-up, she experienced chest pain and an enlarging of the anterior mediastinal tumor and bilateral lung metastases were detected by chest X-ray. The tumor was diagnosed as a primary malignant mediastinal non-seminomatous germ cell tumor by needle biopsy. After initial radiotherapy (12 Gy/4 Fr), she was subsequently treated with EP chemotherapy which achieved a partial response. Complete resection of the residual tumors in the mediastinum and right lung was performed. No recurrence has been noted for 5 years post-operatively.

The reported patient was a 90-year-old woman with anorexia. She was diagnosed with advanced gallbladder cancer that occurred concurrently with stomach cancer. Subsequent to intestinal bypass surgery, S-1(80mg/day)was administered for 14 days, followed by 7 days of rest for one course. Tumor marker levels returned to normal after 4 months. Computed tomography results indicated that, in regard to the gallbladder cancer, the patient had stable disease after 8 months. In addition, gastroscopy revealed a complete response of the gastric cancer after a year. The patient was able to continue treatment as an outpatient until she experienced aspiration pneumonia. The administration of S-1 was terminated after 4 years and 4 months. Treatment with S-1 monotherapy is considered safe for elderly patients, and has the additional benefit that it is deliverable as an outpatient treatment.

The use of stereoscopic images has been spreading rapidly. Nowadays, stereoscopic movies are nothing new to people. Stereoscopic systems date back to 280 A.D. when Euclid first recognized the concept of depth perception by humans. Despite the increase in the production of three-dimensional (3D) display products and many studies on stereoscopic vision, the effect of stereoscopic vision on the human body has been insufficiently understood. However, symptoms such as eye fatigue and 3D sickness have been the concerns when viewing 3D films for a prolonged period of time; therefore, it is important to consider the safety of viewing virtual 3D contents as a contribution to society. It is generally explained to the public that accommodation and convergence are mismatched during stereoscopic vision and that this is the main reason for the visual fatigue and visually induced motion sickness (VIMS) during 3D viewing. We have devised a method to simultaneously measure lens accommodation and convergence. We used this simultaneous measurement device to characterize 3D vision. Fixation distance was compared between accommodation and convergence during the viewing of 3D films with repeated measurements. Time courses of these fixation distances and their distributions were compared in subjects who viewed 2D and 3D video clips. The results indicated that after 90 s of continuously viewing 3D images, the accommodative power does not correspond to the distance of convergence. In this paper, remarks on methods to measure the severity of motion sickness induced by viewing 3D films are also given. From the epidemiological viewpoint, it is useful to obtain novel knowledge for reduction and/or prevention of VIMS. We should accumulate empirical data on motion sickness, which may contribute to the development of relevant fields in science and technology.

Objectives: Owing to the recent rapid advancements in image processing and three-dimensional (3-D) technologies, stereoscopic images can now be viewed on television as well as in theaters and on gaming consoles among others. However, with these advancements, there have also been reports on motion sickness and asthenopia induced by viewing stereoscopic films. Human equilibrium function deteriorates when viewing stereoscopic films, which may lead to motion sickness; however, the exact cause of such motion sickness remains unknown. Therefore, as part of hygiene research that contributes to society, it is important to consider the safety of viewing virtual 3D contents., Methods: In this study, we investigated the effects of viewing 2-D/3-D video clips on the human body by stabilometry, electrogastrography (EGG), and subjective assessments. Seven subjects aged 22 to 24 viewed 2-D/3-D video clips for 60 min., Results: A comparison of time series data obtained at rest shows a significant change in the EGG patterns 20 min after the start of viewing the video clips. Furthermore, sway values while viewing the 3-D video clips were considerably higher than those while viewing the 2-D video clips 60 min after the start of viewing., Conclusions: These findings show that the autonomic nervous system is affected first by long-term viewing of stereoscopic films, and the equilibrium function deteriorates gradually over the course of the exposure.

To evaluate the patient identification ability of radiographers, previous and current chest radiographs were assessed with observer study utilizing a receiver operating characteristics (ROCs) analysis. This study included portable and conventional chest radiographs from 43 same and 43 different patients. The dataset used in this study was divided into the three following groups: (1) a pair of portable radiographs, (2) a pair of conventional radiographs, and (3) a combination of each type of radiograph. Seven observers participated in this ROC study, which aimed to identify same or different patients, using these datasets. ROC analysis was conducted to calculate the average area under ROC curve obtained by each observer (AUCave), and a statistical test was performed using the multi-reader multi-case method. Comparable results were obtained with pairs of portable (AUCave: 0.949) and conventional radiographs (AUCave: 0.951). In a comparison between the same modality, there were no significant differences. In contrast, the ability to identify patients by comparing a portable and conventional radiograph (AUCave: 0.873) was lower than with the matching datasets (p=0.002 and p=0.004, respectively). In conclusion, the use of different imaging modalities reduces radiographers' ability to identify their patients.

Although chronic infection of hepatitis C virus (HCV) induces disorders of lipid metabolism, HCV is known to utilize lipid metabolism for efficient propagation in the liver. Due to the morphological and physiological similarities of HCV particles to lipoproteins, lipid-associated HCV particles are named lipoviroparticles. Previous reports have shown that lipoprotein receptors or cholesterol transporter participate in the entry of lipoviroparticles. In addition, recent analyses revealed that exchangeable apolipoproteins directly interact with the viral membrane to generate infectious HCV particles. In this review, we would like to discuss about involvement of lipoprotein and apolipoprotein in HCV lifecycle.

Background: Although there are reports targeting children with micrognathia, there is no report how orotracheal intubation difficulty of normal adult patients changes with aging. We surveyed orotracheal intubation episodes after more than 20 years from the initial surgery., Methods: Seventy one patients underwent general anesthesia again after 23 years in average. Change of orotracheal intubation difficulty was checked retrospectively. The same anesthesiologist assessed 73.2% of cases., Results: Intubation of 4 patients became more difficult, in one patient it became easier, and in the remainder did not change. There was no relation between the change in difficulty and presence or absence of maxillary incisor. Restricted neck mobility or opening of mouth caused by progressive musculoskeletal diseases made orotracheal intubation more difficult, Conclusions: We conclude that in adult patients, if there are no changes in the degree of opening mouth and neck mobility, almost all patients remained in the same situation regarding orotracheal intubation after 23 years in average.

We report a case of curatively resected intrahepatic cholangiocarcinoma (ICC) with hepatic artery (HA) and portal vein (PV) reconstruction. A 25-year-old man was diagnosed with ICC. Computed tomography (CT) showed that the tumor had invaded the left and common hepatic duct, the right and left HA, and the main branch of the PV. Because the posterior HA was tumor free, we performed a left trisegmentectomy, PV and HA resection and reconstruction, and a hepatocholangiojejunostomy. Pathological examination revealed a tumor classification of T3, N1, M0, Stage IVB. The patient was discharged on postoperative day 59 and gemcitabine (1,000 mg/m²) was administered as adjuvant chemotherapy. However, abdominal CT revealed peritoneal metastasis 8 months after the surgery. A gemcitabine, cisplatin, and TS-1 (GCS) regimen was selected as treatment, and the patient is alive 13 months after surgery.

Uterine cervical cancer is the most common primary gynecologic malignant tumor in Japan. Conventional cervical screening Papanicolaou (Pap) test has been shown to be extremely effective in reducing cervical cancer incidence and mortality, but the consultation rate for cancer screening in Japan is markedly low, at 20% of prescribed subjects, in comparison with other developed countries. In 2001, 15,501 women (6.8%) received a Pap test in Kitakyushu City, and that was less than half of national average. From 2009, free coupons for uterine cervical cancer screening were distributed to Japanese woman who were 20, 25, 30, 35 or 40 years of age as part of the project for women-specific cancer screening. The rate of participation in Pap testing was 22.3% in 2012, with 31,970 women receiving cervical tests. It was almost as high as the national level. It's obvious that high risk human papillomavirus (HPV) is responsible for cervical cancer incidence and HPV mainly infects through sexual practice. The rate of early cervical neoplasms and invasive cancers is currently increasing in young women. Abnormal Pap tests were detected in 2.3% of the women in 2008. To increase the population's participation in this screening process, a cost-effective and efficient system should be established. National and local governments, medical institutions, companies, and educational institutions must have an accurate understanding of the current situation, and take an assertive approach in order to decrease the mortality rate of uterine cervical cancer.

We report 2 cases of human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer successfully treated with a combination therapy of S-1, cisplatin( CDDP), and trastuzumab followed by curative resection. Case 1 involved a 62-year-old man with type 3 HER2-positive gastric cancer spanning the antrum of the stomach to the duodenal bulb and directly invading the pancreatic head( cT4b[ Panc] N3H0P0M0, Stage IIIC). We diagnosed it as an unresectable cancer, and selected S-1, CDDP, and trastuzumab for combination chemotherapy. S-1 (120 mg/body/day) was administered orally for 2 weeks, followed by 1 drug-free week as a course, and CDDP (60 mg/m2) and trastuzumab (8 mg/kg loading dose and 6 mg/kg maintenance) were administered by intravenous infusion on day 1. After the third course, significant tumor and lymph node reduction was observed; however, pyloric stenosis developed. Distal gastrectomy with D2 lymphadenectomy was performed. Case 2 involved a 62-year-old woman with type 4 HER2-positive gastric cancer from the angle of the stomach to the duodenal bulb and directly invading the pancreatic head (cT4b [Panc] N2H0P0M0, Stage IIIC). After the third course of combination therapy, significant tumor reduction and disappearance of lymph nodes metastasis was observed. We diagnosed the patient as having a resectable cancer, and performed distal gastrectomy with D2 lymphadenectomy.

We report a case in which recurrent pancreatic metastasis of renal cell carcinoma( RCC) in the remnant pancreas was resected 6 years after subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). A 74-year-old man underwent right nephrectomy for RCC in 1991, left partial nephrectomy for left renal RCC metastasis in 1996, and SSPPD for pancreatic RCC metastasis in 2007. In November 2012, he was referred to our hospital with a tumor in the remnant pancreas, as seen on abdominal computed tomography (CT). Partial pancreatectomy for the recurrent metastatic RCC in the remnant pancreas was performed in January 2013. The tumor was histologically diagnosed as metastasis from clear cell RCC in the remnant pancreas. The postoperative course was uneventful, and the blood glucose level after surgery was well controlled using an oral hypoglycemic agent.

A 51-year-old woman diagnosed as having left breast cancer with axillary lymph node and liver metastases seven years earlier was seen in our office because of severe pancytopenia. She had received chemotherapy including several cycles of doxorubicin plus cyclophosphamide and docetaxel followed by hormone therapy containing leuprorelin and tamoxifen over four years. For management of bone pain due to metastasis, she had also undergone stereotaxic radiation therapy of the neck one and a half years earlier and unsealed internal radiation therapy with (89)Sr injection five months prior to the current presentation, Subsequently, myelosuppression progressively worsened and she finally required a blood transfusion. Although bone marrow examination showed severe hypoplasia, but neither blastic nor dysplastic, a test for PML-RARA fluorescence in situ hybridization was positive. After administration of all-trans retinoic acid, hematogenesis improved within three weeks. Neither disseminated intravascular coagulation nor retinoic acid syndrome was observed during the course of her illness. This is the first report describing acute promyelocytic leukemia after administration of (89)Sr, to our knowledge, and with an atypical onset and progression. As the number of cancer survivors increases due to improvements in medical intervention, clinicians must take more notice of special characteristics of therapy-related leukemia modified by previous treatments.

In this study, we evaluated the image distortion of three magnetic resonance imaging (MRI) systems with magnetic field strengths of 0.4 T, 1.5 T and 3 T, during stereotactic irradiation of the brain. A quality assurance phantom for MRI image distortion in radiosurgery was used for these measurements of image distortion. Images were obtained from a 0.4-T MRI (APERTO Eterna, HITACHI), a 1.5-T MRI (Signa HDxt, GE Healthcare) and a 3-T MRI (Signa HDx 3.0 T, GE Healthcare) system. Imaging sequences for the 0.4-T and 3-T MRI were based on the 1.5-T MRI sequence used for stereotactic irradiation in the clinical setting. The same phantom was scanned using a computed tomography (CT) system (Aquilion L/B, Toshiba) as the standard. The results showed mean errors in the Z direction to be the least satisfactory of all the directions in all results. The mean error in the Z direction for 1.5-T MRI at －110 mm in the axial plane showed the largest error of 4.0 mm. The maximum errors for the 0.4-T and 3-T MRI were 1.7 mm and 2.8 mm, respectively. The errors in the plane were not uniform and did not show linearity, suggesting that simple distortion correction using outside markers is unlikely to be effective. The 0.4-T MRI showed the lowest image distortion of the three. However, other items, such as image noise, contrast and study duration need to be evaluated in MRI systems when applying frameless stereotactic irradiation.

The paste form of calcium phosphate cement is often used in skull reconstruction because of the biocompatibility and early handling of these cements. Although it had rarely been shown to produce a foreign body reaction, we encountered a patient who experienced an allergic reaction to calcium phosphate cements(Biopex®. A patch test was performed and a positive reaction to magnesium phosphate was obtained. Biopex® contains magnesium phosphate, so we diagnosed this case as allergic reaction. Pathological analysis revealed infiltration of plasmacytes in the bone flap around the calcium phosphate cement. The postoperative course was uneventful 3 years after surgery. Allergy to calcium phosphate cements is rare, but must be considered in differential diagnosis of its side effects.

We report the case of a 71-year-old woman suffering from advanced sigmoid colon cancer with Virchow's and para- aortic lymph node metastasis. Sigmoidectomy was performed for sigmoid colon cancer in January 2008, and pathological analysis revealed that it was Stage II(pT3, pN0, pM0, Cur A). The patient received capecitabine regimen as adjuvant chemotherapy from February 2008 to July 2008. However, in August 2008, a left cervical mass was detected associated with swelling, which was partially resected. Microscopic findings revealed lymph node metastasis from sigmoid colon cancer, and Virchow's and para-aortic lymph node metastasis were diagnosed. Therapy with FOLFOX and bevacizumab (Bmab) was started and continued for 8 cycles. Virchow's and para-aortic lymph node metastasis could no longer be detected in June 2009. FOLFOX+Bmab treatment was administered for 33 cycles and oxaliplatin was temporarily stopped due to adverse reactions, including neutropenia, peripheral neuropathy, and appetite loss. She had no recurrence for almost 3 years after stopping chemotherapy for Virchow's and para-aortic lymph node metastasis.

Hepatitis C virus (HCV) exhibits a narrow host range and a specific tissue tropism. Studies on HCV life cycle have been progressed by the developments of in vitro replication and infection systems and an HCV laboratory strain (HCVcc) capable of propagating in human hepatoma cell line, Huh7 cells. Mice expressing four human entry receptor candidates for HCV permit entry of HCVcc, therefore tissue tropism of HCV was believed to be rely on the expression of the entry receptors. However, HCV infection is often associated with extra-hepatic manifestations and the determinants for cell tropism of HCV remain elusive. Recently, we have shown that several nonhepatic cell lines permit HCV-RNA replication through an expression of a liver-specific microRNA, miR-122, upon infection with HCVcc, while no infectious particle was produced. In the nonhepatic cells, only small numbers of lipid droplets and low levels of VLDL-associated proteins were observed in compared with Huh7 cells, suggesting that expression of miR-122 and functional lipid metabolism participates in the replication and assembly of HCVcc, respectively In this review, we would like to discuss about involvement of miR-122 and functional lipid metabolism in the determination of HCV cell tropism.

A 78-year-old woman was admitted because of persistent cough, fever and sputum for one week. She had been treated with radiation therapy for inoperable thymoma complicated by severe heart failure and had been suffering from recurrent pneumonia and otitis media since then. A chest radiograph on admission showed an anterior mediastinal mass shadow and infiltrates in the bilateral lower lung fields. Serum gamma globulin was decreased and erythroid cells in the bone marrow were markedly decreased. Thymoma with hypogammaglobulinemia is called Good syndrome. We reported this very rare case of Good syndrome. After improving the infection, cyclosporine A was administered for PRCA and hypo-gamma globulinemia, but we discontinued this due to liver dysfunction. We have been currently continuing her treatment with red blood cell transfusion and immunoglobulin supplement only.

Objectives: Constipation affects as many as 26% of elderly men and 34% of elderly women and is a problem that has been related to a diminished quality of life. The aim of this study was to investigate the influence of aging on electrogastrograms (EGGs). On the basis of the EGGs of elderly individuals, the effect of hot stupe application on the epigastrium was also evaluated., Methods: The first group included 14 healthy, young participants (age, 20-25 years) and the second group comprised 14 healthy, elderly participants (age, 65-76 years). EGGs were obtained for the first 30 min in a sitting position and for the next period (> 150 min) in a supine position. A hot stupe was placed on the epigastrium of each elderly patient 90 min after the postural change. We evaluated EGGs by spectral analysis and nonlinear analysis., Results: On comparing the gastrointestinal electrical activity of the elderly group with that of the young group, the activity in the former revealed an overall decrease. With hot stupe application, translation error in the elderly individuals was significantly larger than that without hot stupe application (p < 0.01). We also observed a gender-specific characteristic, wherein the gastrointestinal motility of the young women was likely only influenced by postural change. Moreover, the translation error in the EGGs of the elderly individuals increased during hot stupe heating., Conclusions: This increase in the translation error suggests that the electrical synergy between the stomach and intestine could be enhanced by the application of a hot stupe. Our findings also indicated that hot stupe application on the epigastrium was effective for improving gastrointestinal motility in elderly individuals.

In general, gastrointestinal motility tests cause pain; therefore, the establishment of noninvasive methods is desired. Noninvasive methods facilitate the measurement of motility close to the normal physiological state, can provide new findings, and may contribute to the development of associated fields. Electrogastrography (EGG) is a gastrointestinal motility test in which gastrointestinal electric activity is measured. Compared with other gastrointestinal motility measurement methods such as the gastric emptying and internal pressure measurement methods, EGG is noninvasive and allows measurement under minimum restriction; therefore, measurement for a long time is also possible. In addition, since gastrointestinal electric activity, which cannot be quantified using other methods, can be measured, EGG is applicable to the evaluation of the state of the body and pathological conditions, and may provide new findings such as those useful for the prevention of gastrointestinal dysfunction associated with various disorders. EGG is also useful for preventing disorders associated with abnormal gastrointestinal activity such as functional dyspepsia, which has been more frequently observed in recent years, and constipation, which is an extremely frequent complaint in the elderly. Thus, EGG is of marked importance in public health. However, the range of EGG utilizations and applications is still limited at present. Therefore, we outlined the measurement/analysis methods, the advantages and problems of EGG and electrogastroenterography (EGEG), described their clinical importance, and also commented on forefront studies on EGG and evaluated its prospects.

Objectives: To establish a method for the development of a mathematical model of autonomic activity in gastrointestinal movements and to basically evaluate of the application of the nonlinear analysis method to electrogastrography, we performed feature extraction of electrogastrographic changes in healthy elderly and gastrectomized subjects., Methods: The subjects consisted of 9 healthy elderly males and 3 elderly males without constipation who had undergone resection of 2/3 of the stomach. Electrogastrograms were obtained in a sitting position for 30 minutes and in a supine position for 90 minutes. Spectrum analyses of electrographic time series, the maximum Lyapunov exponent for the evaluation of the chaos of dynamic systems forming time series, and translation error for the evaluation of the smoothness of the attractor orbit were performed., Results: The maximum Lyapunov exponent was a positive number in all analysis intervals in all subjects. This suggests the irregularity of electrogastrograms in gastrectomized subjects. The translation error in the gastrectomized subjects was higher than that in the healthy elderly subjects, showing irregularity. However, as a result of spectrum analysis, gastric electric activity was predominant on electrogastrograms of the healthy elderly subjects, but intestinal electric activity was predominant in the gastrectomized subjects., Conclusions: Differentiation between healthy and gastrectomized elderly people is difficult using only one of the spectrum analysis methods, the maximum Lyapunov exponent, or the translation error. However, since the extracted features differed among the 3 analysis methods, differentiation and diagnosis may be possible using a combination of these methods.

A 61-year-old man was admitted for evaluation of an abnormal chest abnormal with progressive swelling in both hands, clubbing of all fingers and toes, and polyarthroceles. He was given a diagnosis of pulmonary hypertrophic osteoarthropathy (PHO) associated with primary lung cancer, and underwent an upper left lobectomy. Histopathological analysis revealed stage IIB adenocarcinoma of the lung with K-ras mutation, but with no evidence of epidermal growth factor receptor (EGFR). Postoperatively, his symptoms rapidly improved, and the preoperatively observed high levels of serum vascular endothelial growth factor (VEGF) and interleukin 6 (IL-6) decreased to normal levels after just 1 month. VEGF and IL-6 caused by the genetic mutation of K-ras might play a role in the pathogenesis of PHO with lung cancer.