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Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China and subsequently spread worldwide. In Japan, many clusters occurred during the first wave in 2020. We describe the investigation of an early outbreak in a Tokyo hospital. Methods: A COVID-19 outbreak occurred in two wards of the hospital from April to early May 2020. Confirmed cases were individuals with laboratory-confirmed SARS-CoV-2 infection linked to Wards A and B, and contacts were patients or workers in Wards A or B 2 weeks before the index cases developed symptoms. All contacts were tested, and cases were interviewed to determine the likely route of infection and inform the development of countermeasures to curb transmission. Results: There were 518 contacts, comprising 472 health-care workers (HCWs) and 46 patients, of whom 517 were tested. SARS-CoV-2 infection was confirmed in 42 individuals (30 HCWs and 12 patients). The proportions of SARS-CoV-2 infections in HCWs were highest among surgeons, nurses, nursing assistants and medical assistants. Several HCWs in these groups reported being in close proximity to one another while not wearing medical masks. Among HCWs, infection was thought to be associated with the use of a small break room and conference room. Discussion: Nosocomial SARS-CoV-2 infections occurred in two wards of a Tokyo hospital, affecting HCWs and patients. Not wearing masks was considered a key risk factor for infection during this outbreak; masks are now a mandated countermeasure to prevent the spread of SARS-CoV-2 infection in hospital settings.

Liposomal-amphotericin B (L-AmB) is used for cutaneous leishmaniasis (CL); however, its treatment failure has not yet been described in detail. A 58-year-old man returned from the Republic of Venezuela with a cutaneous ulcer on his left lower leg. The causative pathogen was Leishmania braziliensis. We started L-AmB 3 mg/kg/day for 6 days; however, the ulcer did not resolve. The patient was successfully retreated with a higher dose L-AmB 4 mg/kg/day 9 times (total, 36 mg/kg). If L-AmB fails to treat CL and other therapeutics cannot be used, increasing the L-AmB dose is a viable option.

Introduction We reported, in our previous study, a patient with coronavirus disease 2019 (COVID-19) who was successfully treated with extracorporeal membrane oxygenation. Data on clinical courses and outcomes of critically ill patients with COVID-19 in Japan are limited in the literature. This study aimed to describe the clinical courses and outcomes of critically ill patients with COVID-19 in Tokyo, Japan. Methods This is a single-center case series study. Patients with COVID-19 treated with mechanical ventilation (MV) were reviewed retrospectively. Data on baseline characteristics, in-hospital treatment, and outcomes were collected. Results Between February 2, 2020, and June 30, 2020, 14 critically ill patients with COVID-19 were treated with MV. Most patients were male and had comorbidities, especially hypertension or diabetes; 35.7% were overweight and 21.4% were obese. The majority of the patients had dyspnea on admission. The median duration of MV was 10.5 days, and the 28-day mortality rate was 35.7%. In the four patients with COVID-19 who died, the cause of death was respiratory failure. Conclusions As in previous reports from other countries, the mortality rate of patients with COVID-19 requiring intensive care remains high in Tokyo. Further study on the appropriate timing of MV initiation and specific treatments for critically ill patients with COVID-19 is needed.

Introduction The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information. Methods J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis. Results Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers’ diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever. Conclusions We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.

Let S n ⊂ R n + 1 , n ≥ 3 , be the unit sphere, and let S Θ ⊂ S n be a geodesic ball with geodesic radius Θ ∈ ( 0 , π ) . We study the bifurcation diagram { ( Θ , ‖ U ‖ ∞ ) } ⊂ R 2 of the radial solutions of the Emden–Fowler equation on S Θ Δ S n U + U p = 0 in S Θ , U = 0 on ∂ S Θ , U > 0 in S Θ , where p > 1 . Among other things, we prove the following: For each p > p S ≔ ( n − 2 ) ∕ ( n + 2 ) , there exists Θ ∈ ( 0 , π ) such that the problem has a radial solution for Θ ∈ ( Θ , π ) and has no radial solution for Θ ∈ ( 0 , Θ ) . Moreover, this solution is unique in the space of radial functions if Θ is close to π . If p S p p JL , then there exists Θ ∗ ∈ ( Θ , π ) such that the problem has infinitely many radial solutions for Θ = Θ ∗ , where p JL = 1 + 4 n − 4 − 2 n − 1 if n ≥ 11 , ∞ if 2 ≤ n ≤ 10 . Asymptotic behaviors of the bifurcation diagram as p → ∞ and p ↓ 1 are also studied.

In this paper we consider the condensation phenomena of a least-energy solution to semilinear Neumann problems. In precedent studies it has been investigated that the mean curvature of the boundary plays an important role in the condensation phenomena. We prove that a vertex on the boundary plays a similar role in the condensation phenomena, and we obtain the asymptotic profile of a least-energy solution.

Background Ebola virus disease (EVD) was endemic to Africa in 2014–2016. Supportive therapies have been shown to improve the outcome of EVD, and additional supportive therapy including blood transfusion therapy and external circulation could be needed in the event of a future global outbreak. However, pre-transfusion testing policies and guidelines have not yet been established in Japan. Methods We conducted a cross-sectional study of blood transfusion therapy for EVD patients at three designated hospitals for serious communicable diseases in Tokyo. In each hospital, we surveyed blood transfusion therapy policy, blood transfusion protocol, presence of a specialist in the department of transfusion medicine, facility capacity for pre-transfusion compatibility testing, and types of personal protective equipment available. Results One hospital had a cross-matched compatible blood transfusion policy, one had a cross-matched compatible blood transfusion policy only when the patient's ABO and RhD type is previously known, and the third had not created a policy. Two hospitals had a department of transfusion medicine. These two hospitals had a special testing unit for serious communicable diseases, while the other had a portable unit for testing. There were no major differences noted in available personal protective equipment. Conclusion Policies and protocols differ among hospitals. The choice of blood transfusion policy and pre-transfusion testing is largely dependent on equipment and human resources. Further discussion is required to develop national guidelines for blood transfusion therapy in patients with serious communicable diseases, including countermeasures against complications and ethical issues related to the safety of patients and healthcare workers.

Cutaneous leishmaniasis (CL) is gaining attention as a public health problem. We present two cases of CL imported from Syria and Venezuela in Japan. We diagnosed them as CL non-invasively by the direct boil loop-mediated isothermal amplification method and an innovative sequencing method using the MinION™ sequencer. This report demonstrates that our procedure could be useful for the diagnosis of CL in both clinical and epidemiological settings.

症例は39歳,女性,昭和63年12月他院で後腹膜脂肪肉腫摘出術,平成6年11月と平成10年6月に再発のため当院で腫瘍摘出術施行.平成11年6月腫瘍再発が判明し入院治療を予定していたが7月1日突然の高熱をきたし緊急入院となった.翌2日には激しい腹痛が出現し,ショック状態に陥った.右下腹部中心に弾性硬,小児頭大の腫瘤を触知し,右側腹部から背部にかけて皮膚の発赤,腫脹がみられ,著明な圧痛を認めた.腹部CTで腫瘍内部に広範なガス像を認め,さらに腹腔内遊離ガス像と肝内門脈に樹枝状に広がるガス像が認められた.腫瘍の腹腔内ならびに腸管内穿破による敗血症と診断し緊急手術を施行.感染を伴った腫瘍をその周囲に癒着した腸管とともに可及的に摘出し,腹腔内洗浄の後,ドレナージ術を施行した.術後敗血症によるDICを併発したが集中治療により一般状態は回復した.しかし,術後1カ月目頃より急速な腫瘍再発をきたし術後73日目に死亡した.

Eigenvalues of the Laplace-Beltrami operator on a spherical cap is considered under the homogeneous Robin condition. The asymptotic behavior of eigenvalues and the influence of the eigenvalues by the boundary conditions are discussed as the cap becomes large so that the domain covers almost the whole sphere.

症例は73歳男性, 1994年5月,直腸癌(Rs)穿孔による腹膜炎に対し緊急にてHart-mann手術を施行.術後経過は良好で他院にて通院加療を受けていたが, 1998年11月になりCEA, CA19-9の上昇を指摘され,精査目的にて12月当院紹介入院となった.腹部CTおよび超音波検査上肝S6に径約5cmの腫瘤を認め,腫瘤周囲の肝内胆管は限局性に拡張していた.腫瘤は辺縁不整,内部不均一に描出され石灰化を伴っていた.また造影CTでは周囲のみ造影効果を認めた. MRIで腫瘤はT1で低信号, T2で不整な高信号を呈し, MRCPではB6胆管末梢枝の拡張が認められた.胆管内進展を伴った直腸癌肝転移と診断し, S6亜区域切除を施行. B6胆管枝を切開すると胆管内腫瘍栓を認めたため,これを可及的に除去した.摘出標本で腫瘍は6.0×4.0cmでB6胆管枝に直接浸潤し腫瘍栓を形成していた.組織学的には高分化型腺癌であり,前回の直腸癌の組織像と類似しており,直腸癌肝転移と診断した.

A 70-year-old man was referred to the hospital because of an upper abdominal pain, fever and jaundice. Laboratory data showed mild jaundice (T-Bil 4.0mg/dl, D-Bil 3.1mg/dl) and high levels of bile duct enzymes, CRP and CA19-9 (340U/ml). CT revealed a cyst, 9×8cm in size, in the segment 4 of the liver, atrophy of the lateral segment and dilatation of the left intrahepatic bile duct. MRCP revealed the compression of the left hepatic duct by the cyst and a dilatation of the bile duct in the lateral segment. ERCP revealed no communication between the bile duct and cyst, and the left hepatic duct retracted downwards and obstructed by compression of the cyst. Portography via superior mesenteric arteriogram did not demonstrated the left portal branch. After improvement of jaundice and inflammation, a left hepatic lobectomy including the left caudate lobe was performed. The cyst was filled with 500cc of serous fluid, and its wall was smooth. The bile duct in the lateral segment was filled with biliary sludge. Histological examination showed that the cyst wall had single layer of cuboidal epithelium without any malignancy.

A 68-year-old man was seen at the hospital because of epigastric distress. Endoscopic study revealed a tumor in the lower thoracic esophagus. A biopsy showed findings compatible with the diagnosis of poorly differentiated squamous cell carcinoma. A total thoracic esophagectomy were performed, and a cholecystectomy were added to prevent postoperative cholecystitis. The tumor was a type 2 lesion of 4.0×3.5cm in size which was macroscopically blackish in some parts. It was histopathologically diagnosed as malignant melanoma. A polypoid lesion of 3mm in size was also detected in the gallbladder, which was proved to be a metastasis (pT2N2M1, pStage IVb). Since no other primary lesion was seen, the tumor was considered to be primary malignant melanoma. Despite postoperative chemotherapy, he died five months after the operation bucause the tumor had already metastasized to the paraaortic lymph nodes and liver. Primary malignant melanoma arising in the esophagus is rare, and its prognosis is extremely poor. And malignant melanoma rarely metastasize to the gallbladder. Only three cases have been reported in the Japanese literature, but none of them involved primary tumor of the esophagus. We present this case with some bibliographical comments.

Retroperitoneal masses are commonly solid tumors, and rarely cystic ones. In the present paper, we report a case of retroperitoneal serous cyst. A 51-year-old woman complaining of an abdominal tumor visited another hospital and was referred to the hospital, because an abdominal cystic lesion was demonstrated by ultrasonography. The retroperitoneal serous cyst was suspected on various imaging studies and an operation was performed. The tumor was a unilocular cyst 12×6×6cm in diameter, without adhesion to the surrounding tissues. It could be extirpated easily. The specimen weighted 420g. The cyst contained colorless and clear serous fluid, and the cystic wall was thin and was covered with a layer of cylindrical epithlium. Retroperitoneal serous cyst was diagnosed. The levels of CEA and CA125 in the cyst fluid were high, and immunohistological stainings for CEA and CA125 were positive in the epithelium of the cyst. In a review of the literature, the origin of the retroperitoneal serous cyst was mainly discussed, and it was inferred that the origin in the present case might be the remnant of Mullerian duct at the embryonal stage.

A thin film of triphenylaminemethylacrylate was fabricated by physical vapor deposition onto an indium–tin oxide substrate over a temperature range from 230 to 290 K. This thin film was subsequently polymerized by UV irradiation in vacuum with the aim of fabricating electroluminescent devices. Polymerization of the thin film in vacuum was investigated by in-situ FT–IR reflection absorption spectroscopy. UV irradiation achieved a polymer conversion of around 100%. Though the polymerization time increased at the lower temperature of the substrate, the surface flatness of the thin film was improved. The polymerization mechanism was elucidated as a simple radical polymerization on the basis of the order of monomer consumption rate. The number-average molecular weight increased with decreasing UV intensity.

We report a rare case of leiomyosarcoma of the ileum showing a pedunculated extraluminal development, which was succoesbully diagnosed preoperatively. A 69-year-old man visited his primary physician because of lower abdominal discomfort. Abdominal ultrasonography (US) showed a mass in the lower abdomen and he was transferred to the hospital. From the results of imaging studies, especially abdominal angiography, the patient was diagnosed as having a leiomyosarcoma of the ileum. The tumor, 11×10×8cm in size, showed a pedunculated extraluminal growth from the antimesenteric side of the ileum at 100cm from the Bauhin vulve. The ileum including the tumor was excised by a wedge resection. The diagnosis of leiomyosarcoma of the ileum was made based on the histological findings of the resected tumor. The patient has been in good health without any signs of recurrence, as of 1 year after the operation.

We report herein the case of a 38-year-old man found to have a rectal arteriovenous malformation (AVM). The patient was admitted to our hospital for investigation of fresh anal bleeding and general malaise. Barium-enema examination showed a slightly elevated lesion in the rectum, and a selective superior rectal angiogram subsequently revealed an AVM in the peripheral region of the superior rectal artery, which was presumed to be the cause of the anal bleeding. Colonoscopic examination disclosed a submucosal tumor-like lesion in the left posterior wall of the rectum, 3cm above the anal verge. After marking the boundaries by clipping, transanal resection of the lesion was performed. Histological examination revealed an irregularly expanded arteriovenous aggregation in the submucosal layer. The patient had a favorable postoperative course, and no residual AVM was seen on a postoperative selective inferior mesenteric arteriogram. There have been no signs of recurrence in the 2 years since his operation.

The case of a 91-yr-old man who had a tumor of the pancreas head successfully resected is reported. He was admitted to our hospital because of obstructive jaundice, and then percutaneous transhepatic biliary drainage (PTBD) was performed. Cholangiography via PTBD tube showed marked stenosis of the bile duct in the head of the pancreas. Endoscopic retrograde pancreatography (ERP) showed obstruction of the main pancreatic duct in the head of the pancreas, and carcinoma in the head of the pancreas was diagnosed. Abdominal angiography showed stenosis of the celiac trunk caused by compression from the median arcuate ligament, but no tumor stain or encasement in the pancreas was detected. Because the patient had lived an extremely healthy life and had no serious concurrent disease before admission, laparotomy was performed. The tumor in the head of the pancreas was about 2 cm in diameter and restricted inside the pancreas. Pylorus-preserving pancreatoduodenectomy (PpPD) with regional lymph node dissection was performed. The tumor was 1.5 cm in its maximal diameter, and histopathologically was diagnosed as an invasive ductal carcinoma of the pancreas with moderately differentiated tubular adenocarcinoma. The patient had an uneventful postoperative course and now, 3 yr after surgery, he is doing very well and leading a normal daily life.

We report a resected case of carcinoma developed in the reconstructed gastric tube 13 years after esophagectomy for a thoracic esophageal cancer. In February, 1984, he underwent a subtotal esophagectomy and an intrathoracic esophagostrostomy for an early carcinoma in the middle intra-thoracic esophagus (Im). The tumor was superficial and flat type, 2.0×1.5cm in size, and microscopically squamous cell carcinoma (sec) with m, n0, v0, ly0, and in stage 0. Since September, 1996 he had experienced chest discomfort and appetite loss. He visited the department of internal medicine in our hospital, and a pace maker was implanted for sick sinus syndrome in February, 1997. The symptom was not improved and an endoscopic examination showed a gastric carcinoma of type 5 in the lesser curvature of the antrum. So he was referred to the department in March, 1997. Preserving the right gastroepiploic artery and vein, a distal gastrectomy and a Roux-en-Y anastomosis for the remnant stomach and jejunum were performed. Histologically, the tumor was well-differentiated adenocarcinoma with tubl, ss, n(-), ly1, v1, in stage Ib. As of 12 months after the operation, the patient is disease-free without an signs of recurrence. Some bibliographical notes on 65 cases of carcinoma in the gastric tube reconstructed after esophagectomy in Japan are also presented.

We report herein the case of a 35-year-old woman with aplastic anemia who developed hepatocellular carcinoma after long-term therapy with oxymetholone. She was treated with 60 mg/day of oxymetholone for 3 years (total dose 64.8 g). Alpha-fetoprotein, hepatitis B surface antigen, and hepatitis C antibody were all negative, but serum titers of carcinoembryonic antigen and carbohydrate antigen were elevated. Lateral segmentectomy of the liver was performed. The histopathological findings were compatible with those of multiple hepatocellular carcinoma without liver cirrhosis. Three years since the operation, the patient is doing well and no signs of tumor recurrence have been detected. According to our review of Japanese cases of hepatocellular carcinoma associated with anabolic steroid therapy, in all instances the tumors developed after long-term administration of anabolic steroids for hematologic diseases. In patients under long-term anabolic steroid therapy, routine screening of the liver by ultrasonography and computed tomography should be performed to detect liver tumors in the early stages.

We experienced a case of poorly differentiated adenocarcinoma arising in the remnant gastric mucosa with marked extension to the esophageal submucosal layer which developed 20 years after a total gastrectomy for a gastric cancer. A 61-year-old man, who had undergone a total gastrectomy for a gastric cancer at another hospital 20 years before, was admitted to the hospital. There was a history of repeated hospitalization because of malnutrition after the gastrectomy. In a recent endoscopic examination for anemia, redness and easy bleeding in the esophageal mucosa at the anastomotic region was found. The lesion was diagnosed as adenocarcinoma by biopsy. The esophagus in the bdominal and lower thoracic portions including the esophagojejunostomy site was resected. Macroscopic examination of the resected specimen showed a slightly elevated area of the esophageal mucosa at the anastomotic site, but neither color change nor ulcerated lesion was found. In the histological examination, the remnant gastric mucosa was detected and transformation of severe dysplastic epithelium into poorly differentiated adenocarcinoma was observed at the anastomotic site. The carcinoma markedly extended into the esophageal submucosal layer. It was thought that malnutrition after total gastrectomy might be caused by reflux esophagitis. A long-term exposure of the esophagojejunostomy site to enteric juice seemed to be associated with the development of cancer from the remnant gastric mucosa.

Intrasplenic extension of pancreatic tail carcinoma is rather uncommon, and localized intrasplenic invasion, an indication for radical surgery, is extremely rare, because intrasplenic extension of pancreatic carcinoma is mainly found as part of widespread tumor dissemination. A 57-year-old woman was admitted because of left upper abdominal pain. Physical examination of the abdomen showed no abnormal findings. Laboratory data showed mild anemia and marked increased CEA and CA19-9 levels. US, CT and MRI revealed a solid tumor in the splenic hilus, but continuity with the pancreas was unclear. Angiography revealed stenosis of the splenic artery at the pancreatic tail. A tumor arising in the pancreatic tail and extending into the spleen was found at operation, and distal pancreatectomy with splenectomy was performed. No invasion of surrounding tissues or lymph node metastasis was detected. Histological examination revealed moderately differentiated ductal adenocarcinoma of the pancreas. The postoperative course was uneventful. Twelve months after the operation, however, the patient died of multiple liver metastasis.

We consider a positive solution of the Emden equation with the critical Sobolev exponent on a geodesic ball in S3. In the case of the Dirichlet boundary condition, Bandle and Peletier [2] proved the precise result on the existence of a positive radial solution. We investigate the same equation with the third kind boundary condition and obtain a more general result. Namely we prove that the existence and the nonexistence of solutions depend on the geodesic radius and the boundary condition. Moreover the set of solutions consists of a unique radial classical solution and a continuum of singular solutions.

In this paper, a novel VLSI architecture of an Ogg Vorbis decoder is proposed, dedicated for embedded applications. Aimed at the use of the decoder in portable audio appliances, first, the computational cost in a series of decoding processes is analyzed. As a result, the LSP (line spectrum pair) process is detected as a bottleneck to achieving realtime decoding by an embedded processor. Thus, the proposed architecture devises a specific hardware LSP module so as to be integrated into a single chip together with an ARM7TDMI processor. Moreover, our decoder employs fixed point arithmetic, rather than floating point arithmetic, by optimizing the calculation accuracy according to audio quality distortion analysis. The proposed LSP module has been implemented with 9,740 gates, and operates at 58.8 MHz, with the total CPU load reduced by 57%. Audio quality assessment indicated that the use of the fixed point arithmetic does not incur any significant sound distortion.

Thin films of SrAl 2 O 4 :Eu,Dy were prepared by a pulsed ion-beam evaporation method on Si single crystal, soda lime glass, stainless steel and polyethylene substrates at room temperature. In the XRD patterns for the thin films, crystallized SrAl 2 O 4 :Eu,Dy phases were detected in all thin films deposited on the substrates including polyethylene. From these results, we have successfully developed a novel thin film deposition method to prepare crystallized thin films on low-melting-point substrates.

Solid cystic tumor of the pancreas is a primary pancreatic neoplasm of unknown etiology that most commonly occurs in young women and ordinarily contains hemorrhagic tissue. We report herein the unusual case of a 75-year-old man found to have a solid cystic tumor in the body and tail of the pancreas, who is the oldest such male patient to be documented in Japan. The results of laboratory data and imaging studies indicated that the patient had a nonfunctioning islet tumor or solid cystic tumor of the pancreas, and distal pancreatectomy with splenectomy was performed. The diagnosis of solid cystic tumor was confirmed based on macroscopic and histological findings of the resected pancreatic tumor. The patient is currently in good health, without any signs of tumor recurrence 1 year and 4 months after his operation. A total of 181 cases of solid cystic tumors of the pancreas reported in the Japanese literature, including our case, were reviewed to evaluate the clinical differences between patients aged 50 years or over and those younger than 50 years.

We report herein the case of a 53-year-old man with disseminated intraperitoneal metastases caused by the rupture of small hepatocellular carcinoma (HCC). He was admitted to our hospital in shock after suffering a trauma injury to the upper abdomen. Ultrasonography revealed a massive hemoperitoneum. At surgery, 4000 ml of blood was drained from the abdominal cavity and a ruptured tumor, 2 cm in diameter, was found in the right lobe of the liver. The tumor was resected with an adequate surgical margin and subsequent microscopic examination confirmed a diagnosis of moderately differentiated HCC without associated liver cirrhosis. The patient was readmitted 14 months later, following the development of right lower quadrant pain. Ultrasonography and computed tomography revealed extrahepatic abdominal tumors, and abdominal angiography demonstrated four intraperitoneal tumors. At surgery, four implanted metastases adhered to the greater omentum were found and resected. No other tumors were detected. Microscopically, all four tumors were confirmed as moderately differentiated hepatocellular carcinoma. Ruptured HCC may lead to implanted intraperitoneal metastasis, but rupture of small HCC is very rare. While hepatic resection is the treatment of choice for ruptured HCC, according to our review of the literature, only a few patients have survied long-term after resection of implanted metastasis.

We describe herein the case of a 73-year-old woman who developed a giant leiomyosarcoma in the remnant stomach 4 years after undergoing a distal gastrectomy for gastric carcinoma. Abdominal ultrasonography and computed tomography revealed a huge tumor, 22 cm in maximum diameter, in the left hypochondrial region. Selective abdominal angiography showed a hypervascular tumor fed by the branches of the splenic artery and left inferior phrenic artery. The tumor arose from the posterior wall of the remnant stomach, and demonstrated marked extragastric growth and direct invasion of the pancreas, transverse colon, and diaphragm on the left side. Total resection of the remnant stomach with en bloc resection of these adjacent organs was subsequently carried out. We reviewed the Japanese literature on this extremely rare tumor and evaluated its clinical profile. In comparison with leiomyosarcoma of the unresected stomach, that of the remnant stomach more frequently showed endogastric-type growth and was accompanied by ulceration of the gastric mucosa. The prognosis of patients with leiomyosarcoma of the remnant stomach appears to be greatly affected by the presence of liver metastases and the tumor diameter, similar to that of patients with leiomyosarcoma of the unresected stomach.

A case of primary adenosquamous carcinoma of the liver in a patient with an elevated level of serum squamous cell carcinoma-related antigen is reported. A 68-year-old man was admitted to our hospital with a 10-day history of fever and jaundice. From the results of laboratory and imaging studies before surgery, a diagnosis of cholangiocellular carcinoma was made, and the patient underwent right trisegmentectomy with regional lymph node dissection. Histopathological examination of the resected specimen revealed adenocarcinoma, squamous cell carcinoma, and a transitional area containing both types of cancer cells. The number of argyrophilic nucleolar organizer regions and the labeling index of proliferating cell nuclear antigen were markedly elevated and the deoxyribonucleic acid ploidy pattern was aneuploid in the squamous component. The patient died due to liver metastases 3 months after the operation. We reviewed the 31 cases of adenosquamous carcinoma of the liver reported in the Japanese and English language literature, including the present case.

A 79-year-old man was admitted to our hospital because of severe epigastric pain. Ultrasonography and computed tomography revealed a slightly distended gallbladder with a small amount of free intraabdominal fluid. At emergency laparotomy, perforation of the gallbladder was recognized and thus a cholecystectomy was performed. Histopathologically, localized necrosis was seen at the site of perforation: however, the inflammation of the surrounding tissue was mild and no thrombus was detected within the intramural vessels. In addition, the gallbladder contained no stones and a bile culture was negative. Postoperatively, the diagnosis of idiopathic perforation of the gallbladder was established. The findings of this case help to emphasize the importance of considering this disorder in elderly patients presenting with peritonitis of unknown origin.

Two cases of desmoid tumor are presented with a review of 74 cases reported in Japan. The first case was a 38-year-old female with a non-tender mass in the right lower abdominal wall, which was 4.5×2.5×2.0 cm in size and growing invasively within the internal oblique abdominal muscle. The second case was a 39-year-old female with a non-tender mass in the left lower abdominal wall, which was 4.5×4.4×2.5 cm in size and growing invasively within the internal obliaque, rectus and transverse abdominal muscles. Both patients' tumors were resected completely, including the surrounding nomal tissues within 1 cm from the tumor. Defects of the fasciae were approximated primarily by adding multiple incisions in the surrounding fasicae to reduce tension. There has been no evidence of recurrence 2 years and 10 months and 11 months after surgery, respectively. Review of the 74 reported cases indicated this tumor is found more frequently in females aged from 20 to 40. About 90% of tumors originated from the rectus or internal oblique abdominal muscle. US and CT were useful for the diagnosis. Charactristic findings on US were a hypoechoic mass, sometimes heterogenous, with an irregular and slightly unclear margin. Recurrence of the tumor was reported 5 patients (6.8%). It is therefore considered that complete resection is necessary to treat this tumor.

5-Aryl-2-oxazolidinones have been synthesized readily by the elimination of dimethylamine from the corresponding (2-hydroxyethyl)ureas. The ureas are obtainable by the photoreaction of tetramethylurea with para-substituted benzaldehydes (Method A) or with para-substituted methyl benzoates (Method B). The electronic character of the substituent on the benzene ring determines which method is suitable for the preparation of (2-hydroxyethyl)ureas.