This report takes up a 65-year-old woman. Suspecting a tumorous superior fovea in the left clavicle, she consulted with our hospital’s Department of Otolaryngology. As a result of the lymph node biopsy performed at the department, she was diagnosed as having moderately differentiated tubular carcinoma. CT scanning revealed a number of swollen lymph nodes and parietal tylosis in the sigmoid colon. Endoscopy produced no abnormalities in the upper digestive tract, but an endoscopic check of the lower digestive tract revealed an all-around Type II tumor. The ailment was pathohistologically identified as tubular carcinoma. That said, the patient was diagnosed as suffering from sigmoid colon accompanying Virchow lymph node metastasis. Then, sigmoidostomy and the dissection of the D3 lymph node were performed. Pathohistological diagnosis revealed moderately differentiated tubular carcinoma, SE, N3, HO, PO, M1 (Virchow lymph node metastasis), Stage IV. Chemotherapy was postoperatively initiated with mFOLFOX6.

Topical cardiac hypothermia has unequivocal preservation effects during ischemia, but it has some disadvantages. Topical cooling, especially with ice slush, can injure the phrenic nerve, disturb the equal distribution of the cardioplegic solution due to coronary artery spasm and damage the epicardium. It is easy to prevent cooling injury without topical hypothermia, but the myocardial oxygen demands are increased. In order to supply the myocardium with oxygen for the increased oxygen demands during ischemia, isolated rat hearts were immersed in perfluorochemicals (PFC) which have excellent transportation of oxygen. The effects of immersion in PFC during mild hypothermic ischemia (at 20°C without cardioplegia and at 30°C cardioplegic arrest) on the cardiac function on reperfusion were evaluated. Under 20°C hypothermic ischemia without cardioplegia, cardiac beating was maintained for 20±4 minutes in the hearts were immersed in PFC, and for 10±2 minutes in the hearts that were not immersed in any solution. In the recovery of cardiac function (LVDP and LV_max dp/dt) after mild hypothermic (30°C) cardioplegic arrest, the hearts immersed in PFC showed better results than hearts that were not immersed.

  A 86-year-old woman visited us, complaining about sharp abdominal pain she had very morning when she got up. Ultrasound and computer tomography scans of the abdomen revealed notable parietal hypertrophy and swelling of the gallbladder. The old woman was diagnosed with acute cholecystitis and immediately admitted to the hospital. Her condition did not improve on conservative management. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The bile thus aspirated was bloody, which led us to suspect necrotizing cholecystitis. Emergency cholecystectomy was done. The abdominal operation found the gallbladder wandering with a torsion of 360 degrees around the gallbladder neck as the axis and the leakage of bile in the abdominal cavity from what could be presumed to be the area where the PTGBD was placed. After the torsion was corrected, the gallbladder was surgically removed. Neither gallstones nor tumors were found in it. There were signs of hemorrhagic necrosis in the mucus membrane. The patient made good progress after the operation and was discharged on the 15th hospital day. Torsion of the gallbladder is a comparatively rare entity and its symptoms are not always specific. Therefore, it defies preoperative diagnosis. In this paper, we report our experience with a case of this disease which presented characteristic radiographic images and discuss the treatment strategies including PTGBD.

　　Case I was a 85-year-old woman. She was referred to us as her serum CEA level was found as high as 9.2ng/ml at a clinic in her neighborhood. CT and ultrasound scans revealed a cystic tumor in the appendix area. A barium enema examination showed a tubercular lesion in the subcecal area. The surface of the lesion was flat and smooth. The vermiform appendix was not scanned with the contrast medium.　　She was diagnosed with mucinous cystadenoma of the appendix. Partial cecotomy was performed. The postoperative serum CEA fell to a normal level of 4.7ng/ml.　　Case II was also a woman . The 74- year-old inpatient was being treated for high blood pressure and hyperlipemia when her serum CEA level was found elevated to 12.3ng/ml. CT and ultrasonograph examinations revealed a cystic tumor in the appendix area. A barium enema examination showed a mucocele-like tubercle in the appendix. The patient was diagnosed with mucinous cystadenoma of the appendix and partial cecotomy was performed. The CEA level was normalized postoperatively with 1.5ng/ml.　　The pathologic tests confirmed either of these two cases was mucinous cystadenoma of the appendix. Immunohistochemical staining showed a CEA positive.