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Purpose Endometriosis of the umbilicus is rare, with the most common site being laparoscopy scars. We report here a case of spontaneously developed, solitary umbilical endometriosis, not associated with a surgical scar, that was successfully treated with local excision.Case A 44-year-old Japanese woman was admitted complaining of an umbilical mass with cyclic pain, associated with her menstrual cycle. She had noticed the umbilical pain six months earlier. She had not received an abdominal operation or hormonal treatment. Abdominal examination revealed an index-finger-tip-sized, dome-shaped, painful, subcutaneous mass beneath the umbilicus with slightly brownish skin. Gynecologic examination showed a fibroid uterus of double-fist size. Magnetic resonance imaging revealed a subcutaneous mass beneath the umbilicus 1.5 cm in diameter. The umbilical mass was revealed to be high intensity with a small low-intensity area by both T1-weighted and T2-weighted images, suggesting umbilical endometriosis. The patient was treated by local excision of the umbilical mass, and full excision was achieved. Total hysterectomy and right salpingo-oophorectomy were performed simultaneously to treat the uterine fibroid. The pathologic diagnosis of the excised umbilical tissue was endometriosis. Endometriotic or adenomyotic lesion was not detected in the resected uterine and tubo-ovarian tissues. Gonadotropin-releasing hormone antagonist administration for six months was commenced after the surgical treatment. The patient is doing well without evidence of disease four months after surgery.Conclusion Spontaneously developed umbilical endometriosis is rare. Simultaneous laparoscopy or laparotomy should be considered to assess co-existent pelvic endometriosis at the time of surgical treatment in selected cases.

Purpose The aim of this study was to evaluate the long-term patency rate and complications associated with the use of the BBAVF in the early period.Methods The records of all patients undergoing BBAVFs for hemodialysis access between June 2001 and June 2011 were retrospectively evaluated. We allowed the use of the BBAVF beginning two weeks after the fistula creation. The primary and secondary patencies were estimated using the Kaplan-Meier method.Results A total of 44 BBAVFs were created for 41 patients. Most (73.2%) of the patients had previously been on hemodialysis. A previous history of AVG creation was noted in 36.6% and previous insertion of a catheter was reported for 72.7% of the patients, respectively. The mean time to the first cannulation of the BBAVF was 18.8 days (13–42 days). In two cases, the BBAVFs were not used. Postoperative complications were noted in 2 cases, and included prolonged arm edema and thrombosis. There was no infection of the wound or steal syndrome. The primary and secondary patency rates were 68.1% and 84.2% at 1 year, 55.0% and 80.7% at 2 years, and 38.1% and 70.1% at 5 years, respectively.Conclusions In this study, the patency rates following the early use of the BBAVFs were not inferior to the previously reported patency rates in the literature. In cases where the patients already have an inserted central catheter, the early use of the BBAVFs decreases the complications associated with catheters.

Ovarian cancer is the third-most common cancer of the female reproductive tract, yet it has the highest case fatality ratio of all gynecologic malignancies. Approximately 60 of women diagnosed with epithelial ovarian cancer will die of the disease, because the majority of patients are diagnosed with advanced disease. Surgery followed by chemotherapy is the standard approach to the management of advanced epithelial ovarian cancer. The goal of the surgery is optimal cytoreduction prior to the initiation of chemotherapy. As significant survival benefit from optimal cytoreduction has also been shown for patients with advanced disease. The generally accepted definition of optimal cytoreduction today is a residual tumor diameter no greater than 1 cm. However, the surgeon should attempt to achieve complete cytoreduction to a level of no visible disease or microscopic disease. The surgical procedures required to achieve complete cytoreduction depend on the disease distribution. The most common areas of tumor involvement are the paracolic gutters, the small bowel serosal and mesentery surfaces, the diaphragmatic and pelvic peritoneum, the greater and lesser omentum with extension to the transverse colon, and the sigmoid colon affected by direct extension from the ovary. In cases of extensive tumor involvement, optimal cytoreduction may involve a radical en bloc resection of all involved pelvic viscera and associated peritoneum, bowel resection, splenectomy, and diaphragmatic and liver resection. The benefit of such aggressive surgery outweighs the risk of morbidity in the vast majority of patients. This paper is a review of the recent information concerning the definition of optimal cytoreduction, surgical techniques for maximum cytoreduction, and the selection criteria for patients.

Abstract We herein report two patients with end-stage renal failure who complained of disabling claudication due to abdominal aortic atherosclerosis. Both were on chronic hemodialysis for more than 15 years, and their abdominal aorta was densely calcified. We elected to perform a descending aorta to iliac artery bypass in order to avoid hazardous clamping of the calcified aorta. Hemodialyisis was able to be resumed on the first postoperative day. They tolerated the operation well and their symptoms disappeared. This operative procedure is therefore considered to be a useful option for patients with a porcelain aorta who are on chronic hemodialysis.

Abstract.: Retroperitoneal leiomyosarcoma is a rare neoplasm for which complete surgical removal provides the only effective treatment, as local recurrence adversely affects prognosis. However, invasion of major vessels may occur, making complete resection difficult. This report describes the cases of three patients who required concomitant resection of parts of the inferior vena cava because of direct tumor invasion. The major vessels should be isolated in preference to the tumor capsule during surgery to prevent sudden exsanguination or incomplete tumor resection. Resection of a recurrent sarcoma or a solitary metastasis can be effective in selected patients.