Purpose  In a series of our recent studies, systematic mild hyperthermia treatments, such as sauna, hot spring and a special bath for medical treatment, were found to activate leucocytes and to enhance immunity. Although they are known to be effective for health promotion, it is not easy for general people to regularly take these conventional hyperthermia. It would be advantageous for elderly persons, sick people and pregnant women as well as pressed business persons if it is able to minimize stress which might be induced by the conventional hyperthermia, such as high temperature heat, water pressure and humidity. To pursue a further study of the effect of hyperthermia itself, in this research, we utilized nano-mist sauna (NMS), a new hyperthermia treatment. NMS, a new type sauna, is characterized by the ability to produce ultra small fog-shaped hot water called nano-mist, which hardly condenses dew. And we studied the effect of NMS on body temperature, leukocytes, autonomic nerve function and energy production. Method  We obtained peripheral blood from six healthy male volunteers (age, 46.5±8.5 years) before and after NMS hyperthermia (20min, 40°C, 100%RH) for lactate and blood glucose measurement and flowcytometric analysis. Body temperature (hypoglossal) and pulse rates were also measured. The statistical analysis difference between the values was determined by paired t-test and Kruskal-Wallis test. Result  After NMS hyperthermia body temperature and the level of PO2 rose (36.8→37.2°C), (52→61mmHg) (p<0.05). On the other hand, the level of lactate showed decrease in all subjects. The ratio and the numbers of NK cells decreased (21.8→17.7%, 498→436/μL) (p<0.05) while those of B cells increased (9.5→12.1%, 261→349/μL) (p<0.05). Discussion  Several investigators report that the conventional hyperthermia enhances the primordial immune system (i.e. extrathymic T cells, NK cells, NKT cells and granulocytes) via dominance of sympathetic nerve system function (SNS) . Conversely, in our study, those of the conventional immune system (i.e. T and B cells) was enhanced, suggesting suppression of SNS function. It is reported that the expression level of HLA-DR on the B cells was elevated during hyperthermia (body temperature rose). SNS function (hypothermia) is stimulated by stress and it is suppressed by relaxing (hyperthermia) in the opposite. And it is considered that NMS hyperthermia suppressed SNS and that it was also consistent with our result of lactate decrease. It is possible to consider that NMS hyperthermia may impact on autonomic nerve activating leucocytes. Therefore NMS may be a kind of effective health promotion for valetudinarian (ie an infant, a female) and both a caregiver and a caretaker.

A 14-year-old girl (Case 1) with respiratory distress during exercise was referred to our department after a pancreatic mass was detected by computed tomography (CT). Contrastenhanced CT scan showed a low-density mass measuring 2.5 × 2 cm in the body of the pancreas. Low signal intensity was seen on T1-weighted magnetic resonance imaging (MRI) and high signal intensity on T2-weighted MRI. We suspected solid-pseudopapillary neoplasm (SPN) of the pancreas and performed laparoscopy-assisted spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 13. A 15-yearold girl (Case 2) with abdominal pain and fever was referred to our department after an abdominal cystic mass was detected by ultrasound examination. Contrast-enhanced CT showed a 4-cm well-circumscribed mass. Higher signal intensity was seen on T2-weighted MRI. We suspected SPN of the pancreas and performed laparoscopic spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 8. Laparoscopic or laparoscopy-assisted surgery should be considered for SPN of the pancreas.

Here, we report 3 cases of conservatively treated ischemic colitis with hepatic portal venous gas. In Case 1, an 84-year-old man visited the emergency department because of fatigue, vomiting, and upper abdominal pain. In Case 2, a 72-year-old man was hospitalized for rehabilitation in another hospital following cervical spine trauma. He had diarrhea and mesogastric pain for 2 days and was transferred to our hospital. In Case 3, an 89-year-old woman visited the emergency department because of upper abdominal pain and vomiting. In all cases, we diagnosed the illness as ischemic colitis with hepatic portal venous gas based on computed tomography findings, and the vital signs of all patients were stable. They were treated conservatively. They were able to resume oral intake and were discharged or transferred to another hospital. Hepatic portal venous gas has been considered a poor prognostic sign of severe diseases such as intestinal necrosis. However, recently, reports of cases treated conservatively have been increasing. Conservative treatment may be selected for ischemic colitis associated with hepatic portal venous gas taking into account the patient’s general condition.

A 66-year-old, postmenopausal woman was referred to our hospital because of abnormal breast cancer screening results. A tumor was found in the upper outer part of the left breast. Biopsy revealed papillotubular carcinoma, ER (Allred score total score [TS] 3 = proportion score [PS] 2 + intensity score [IS] 1), PgR (Allred score TS 3 = PS 2 + IS 1), HER2 (2+), fluorescent in situ hybridization 1.1 (negative), and Ki-67 labeling index 15%. In diagnostic imaging, the tumor size was 35 mm. The diagnosis was T2N0M0 Stage IIA, luminal B-like breast cancer. First, letrozole 2.5 mg/day was administered as preoperative hormone therapy. After 2 months of treatment with letrozole, the tumor size had increased to 44 mm and preoperative hormone therapy was discontinued. She was started on preoperative chemotherapy (4 courses of epirubicin plus cyclophsphamide followed by 4 courses of triweekly docetaxel). The tumor size decreased, becoming undetectable. After these preoperative treatments, nipple-sparing mastectomy, sentinel lymph node biopsy, and breast reconstruction with a primary latissimus dorsi flap were performed. As of 3 years and 6 months after the operation, there has been no recurrence. At first, preoperative hormone therapy is performed for Luminal B-like breast cancer as in this case, if the response is insufficient, preoperative chemotherapy after hormone therapy may be a therapeutic option.

Primary mesenteric neuroendocrine tumor is extremely rare. Here we describe 2 cases of this disease. Case 1 was a 66-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. There has been no recurrence as of 25 months after surgery. Case 2 was an 80-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who also underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. This is recurrence-free as of 36 months after surgery. Several cases of primary mesenteric neuroendocrine tumor have been reported, but most have been treated with open surgery. To date, there has been only 1 case of primary mesenteric NET that was resected in a pure laparoscopic procedure. In all 3 cases (including our 2 cases), the largest tumor diameter was 4 cm. It appears that laparoscopic surgery can be used to treat primary mesenteric neuroendocrine tumor of small size (＜ 4 cm) with minimal invasion.