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I showes the result of treatment of malignant diseases in digestive organs for last 20 years on our hospital.In Niigata prefecture, esophageal and gastric cancer cases are higher more than Japanese mean frequency of them.We have about 200 cases of gastric cancer every year. Out of them, operable cases have been decreased gradually, because of increase in cases done EMR (endoscopic mucosal resection).In operation method, total gastrectomy and pyloric resection cases decreased due to improve patient's QOL. Anticancer chemo-therapy into inoperable patients were done by new anticancer drugs, especially, combination therapy of TS-1 and paclitaxel is most effective compared of other drugs and combinations, that is, 13 months in mean survival time were performed.Number of cases of esophageal cancer has been increasing slowly, however, operable cases were not increasing, because of increasing of EMR. Presently, frequency of operation, EMR and chemotherapy with irradiation is almost similar.Number of cases in colon cancer has been increasing yearly, following colonofiberscopy (CF) with EMR or polypectomy (PP).Almost of advanced colon cancers were operable with laparostomy, however, before several years, laparoscopic colectomy (LAC) was performed, then, it reached to 40% among operable cases. By LAC, hospital period was shortened about a half of laparostomy.Number of cases of hepatocellular carcinoma (HCC) has been not increasing, so, cases of hepatic resection was stationary, because of TAE (transarterial embolization), RFA (radiofrequency ablation) and PEIT (percutaneus ethanol injection therapy) performed actively.Out of them, 5 year survival rate of lower biliary tract cancer patients were more higher than upper ones.Hereafter, based on above results, we have to make a effort to form a system of a cancer therapy, from prevention, diagnosis, and therapy to terminal care.
Therapeutic procedure ; Number ; Excision ; Digestive ; seconds

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To evaluate clinical courses at teaching hospitals outside of Osaka City University Hospital, we used a questionnaire to ask instructors and sixth-year students about practical problems immediately after the end of the semester. This course was conducted for 7 weeks during the first semester at 24 hospitals and for 5 weeks during the second semester at 23 hospitals. In each semester about 40% of clinical practice at teaching hospitals was done in the style of clinical clerkships. About 90% of students were mostly or completely satisfied with their instructors and hospitals. Furthermore, about 70% of instructors felt more or less fulfilled by working with students and about 60% of them felt working with students was rewarding. More than 95% of instructors would be willing to teach medical students again. In conclusion, most instructors and students felt that clinical courses at teaching hospitals outside of Osaka City University Hospital were conducted without problems.

A 42-year-old woman with antiphospholipid syndrome (APLS) secondary to systemic lupus erythematosus (SLE) complicated with thrombocytopenic purpura was successfully treated by mitral valve replacement with a mechanical prosthesis and tricuspid valve annuloplasty for mitral valve stenosis and regurgitation due to Libman-Sacks endocarditis. Intraoperative hemorrhagic oozing due to thrombocytopenia was effectively managed with platelet transfusion. Negative microbial culture and pathological examination of the resected mitral valve demonstrated an atypical sterile verrucose lesion, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was successfully discharged 31 days after the operation without any hemorrhagic or thromboembolic events. However, 100 days after surgery, she suffered from fatal cerebral infarction caused by poor Coumadin compliance. Regarding the prosthetic valve selection, it is reasonable to select the mechanical valve because 1) anticoagulation therapy is necessary for APLS, 2) the risk of the dialysis induction due to the lupus-induced renal failure leading to a high calcium turnover, which results in accelerated bioprosthetic valve calcification. In case of SLE with APLS, in which anticoagulation and antiplatelet therapy is required to prevent the thromboembolic event and thrombocytopenic purpura, after valve replacement, strict management of anticoagulation plays an essential role to prevent thromboembolic complication.

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) infectious endocarditis (IE) which was successfully treated with linezolid (LZD). The patient was a 44-year old woman. She was referred to our hospital because of fever of unknown origin. MRSA was detected from blood cultures and echocardiography revealed vegetation on the right coronary cusp of the aortic valve. She was diagnosed with MRSA endocarditis according to the Duke criteria, and was immediately give vancomycin (VCM) and isepamicin. Sixteen days after administration of VCM, she had a progressively increasing skin rash. It was considered a side effect of antibiotics and VCM was replaced with teicoplanin (TEIC). Eventually, LZD was given to her at 22 days after hospitalization because TEIC was not effective. LZD alleviated the fever and diminished the signs of vasculitis due to endocarditis within a week. LZD was continued for 4 weeks with cardiac failure medically controlled, and she underwent aortic valve replacement using a mechanical prosthetic valve. LZD was injected just before the operation and continued for 15 days postoperatively, followed by oral administration of levofloxacin. She was discharged 35 POD and no recurrence of the infection had been observed at 1 year after the surgery. LZD could be an alternative therapy for MRSA endocarditis, but further examinations are warranted to determine the most appropriate regimen.

OBJECTIVES: There is increasing evidence that systemic inflammatory response (SIR) markers are prognostic factors for various types of cancers. This is the first study to evaluate the usefulness of SIR markers for the prognosis of early-stage ovarian clear-cell carcinoma (OCCC). METHODS: We retrospectively investigated 83 patients diagnosed with stage I–II OCCC who underwent surgery between 2005 and 2017. Initially, receiver operating characteristic curve analysis for overall survival (OS) was used to determine optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Patients were stratified into 2 groups by the cut-off values (NLR=3.26, PLR=160). Univariate and multivariate analyses were performed to elucidate the significance of SIR markers as prognostic factors. RESULTS: In the median follow-up period of 64.1 months, 16 patients experienced recurrence, and nine patients died. The Kaplan-Meier curve showed that OS of the NLR-low group was significantly longer than the NLR-high group (p=0.021). There was no significant difference in progression-free survival between the 2 groups (p=0.668), but the post-recurrence survival of the NLR-low group was significantly longer than the NLR-high group (p=0.019). Furthermore, multivariate analysis showed that increase in NLR is a significant independent prognostic factor for poor prognosis (hazard ratio=7.437, p=0.017). There was no significant difference between PLR-low and PLR-high group. CONCLUSION: Results suggest that NLR can be a significant independent prognostic factor for early-stage OCCC.
Adenocarcinoma, Clear Cell ; Biomarkers ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis ; Recurrence ; Retrospective Studies ; ROC Curve

A 52-year-old man had a history that included aortic valve replacement due to infectious endocarditis in 1987. Chest X-ray showed slight enlargement of the superior mediastinum in 1998, but the enlargement was very mild and there had not been any significant change since 1998. However, chest X-ray demonstrated an extremely protruding mass on the right side of the superior mediastinum in May 2004 and a pseudoaneurysm located in the ascending aorta was demonstrated by computed tomography. We considered this aneurysm had been caused by ascending aortic cannulation for blood return from cardiopulmonary bypass (CPB) during the previous surgery. On re-operation, CPB was established by femoro-femoral bypass and median sternotomy was performed. The pseudoaneurysm measured 60mm in diameter and there was a felt-pledget on top of the aneurysm. Under deep hypothermic cardiac arrest, we incised the aneurysm and closed the orifice of the pseudoaneurysm using a patch (Hemashield Woven Fabrics). On pathological examination, the wall of the pseudoaneurysm showed a structural loss of the blood vessel and the felt-pledget had been exposed to the inferior of the aneurysm breaking through the wall. We considered this a non-mycotic pseudoaneurysm because of this patient's clinical course, surgical and pathological findings. We encountered a pseudoaneurysm in the ascending aorta that was detected and treated surgically about 20 years after aortic valve replacement.

Aim:The usefulness of high-density barium, which was made to 150w/v% (MIX150), was examined to obtain better radiographs of the intestines. Methods: “MIX150” was compared with existing pharmaceutical “BAM100” to evaluate x-ray images (barium adhesion, dryness evaluation). MIX150 was used in 232 patients (mean age 56 years), while BAM 100 in 210 patients (mean age 55 years). Results: In terms of adhesion, MIX150 was excellent in the the cecum significantly and in dryness evaluation, in the entire region of the colon. Conclusion: High-density barium (150w/v%) was useful for enhancing the quality of radiographic images.
physical density ; Euphoric mood ; Roentgen Rays ; Barium ; Lower case vee