The patient is a women in her 60s. After medical examinations, she was told that the result of fecal occult blood reaction testing was positive. Moreover, colonoscopy found type 2 cancer in her sigmoid colon. The patient underwent sigmoidectomy. The 3D dissection of lymph node and colorectal side-to-end anastomosis were performed. Pathologically, the case was diagnosed as moderately differentiated adenocarcinoma (stage II). Adjuvant chemotherapy was not given. During follow-up observation, the tumor marker levels were elevated above normal. A work-up revealed a recurrence of the cancer on the abdominal wall. The lesion was surgically removed with a margin of about 2 cm from the tumor secured. Pathological diagnosis of this recurrent case was not inconsistent with the previous diagnosis of sigmoid colon cancer. As the relapse was thought to be due to the implantation of cancer cells in the abdominal wall, we need to follow the surgical procedure with scrupulous care and exercise the utmost precaution to protect incision wound on the abdominal wall.

The short wave diathermy was utilized on the 25 patients with rheumatoid arthritis suffering from the pain of the knee joint and therapeutic effects were evaluated.
Ito rator K-I, a short wave generator for the treatment at home (voltage: 100v, 28MHZ), was applied on the painful knee joint daily for 20 minutes.
The therapeutic effects were assessed by the findings before and after daily single application of the short wave diathermy (I), and also by the findings after a series of the treatments during a month (II).
In the latter case, the short wave diathermy was utilized for 20 minutes every morning between nine and ten except on Sundays.
For the purpose of the evaluation of the therapeutic effects, six items of the studies were selected, including (1) points of the joint pain, (2) A-ROM of the knee flexion, (3) gait time for 10 meters, (4) time between the flexion and extension, (5) extensor muscle strength of the knee, and (6) flexor muscle strength of the knee.
The results were as follows:
(1) The knee joint pain was improved after daily single application of the short wave diathermy and the decrease in their pain points was 30 per cent.
(2) Gait time for 10 meters and time between the knee flexion and extension (10 times) were significantly improved after daily single application of the short wave diathermy.
(3) After a series of treatments of thort wave diathermy during a month some improvements were showed on the all items, but every improvements was not significant.

　　Although axillary lymph node dissection (ALND) is conventionally indicated for metastasis in the sentinel lymph node (SLN), the omission of ALND is being discussed more often in recent years. However, because of the lack of specific guidelines, it is unclear which cases should be treated without ALND. In this study, we performed one-step nucleic acid amplification of the SLN with metastasis to determine the total tumor load (TTL), that is, the number of cytokeratin (CK) 19 mRNA copies. After ultrasonography (US) of ALN, the ultrasonographic findings were combined with TTL to rate SLN metastasis. In the rating, a total score was obtained by assigning 1 point each for (a) TTL of ≥15000 copies/μL, (b) US findings of a long-to-short LN diameter ratio of ≤2, and (c) US findings of no echogenic hilus. We then investigated the association between the total score and metastasis in the non-SLN. Results showed that while 87.5% (5/6) of patients with positive non-SLN scored ≥2 points, only 3.1% (1/34) of patients with negative non-SLN did so, suggesting that a total copy number of CK19 mRNA, US findings of a long-to-short LN diameter ratio, and the presence/absence of echogenic hilus are important predictors for non-SLN metastasis. This novel scoring system is expected to help determine which patients need ALND or what postoperative therapy is necessary.

This study was designed to clarify the usefulness and pitfalls of hypothermic management after Fontan's operation. Twenty-five patients who underwent Fontan's operation and received hypothermic management in an acute postoperative phase from 1974 to 1991 were divided into two groups; the alive (S) group and the dead (D) group. The lowest rectal temperature during the procedure was 32°C on average. There were no significant differences in preoperative indices of pulmonary circulation and renal function. After rewarming, PaO₂ and daily urinary output were increased and central venous pressure decreased significantly in the S group. In all S group patients, urinary output was increased during hypothermia irrespective of peritoneal dialysis. Anuria occurred 2 days on average after induction of hypothermia in D group. Urinary output in D group decreased significantly for 4 days compared to S group. On the other hand, it was possible to save two patients who underwent take-down of Fontan's operation within 6 hours after the onset of anuria. We conclude that hypothermic management is useful in serious cases after Fontan's operation and that daily urinary output in relation to body weight during hypothermia is most important as an index of post operative circulation.

In Japan there are many people who are intolerant to alcohol. Known as flushers, they do not genetically have low Km acetaldehyde dehydrogenase (AlDH₂). Flushers are judged easily and accurately by the alcohol patch test. An ethanol patch test carried out on agricultural and fishing populations in Japan showed that approx. 40% were deficient in AlDH₂. A questionnaire survey of the drinking behavior of many people showed significant differences between the normal AlDH₂ and AlDH₂-deficient groups. The normal group drinks positively and actively, while the deficient group drinks negatively and passively. As a result, there were significant differences in subjective and objective symptoms that result from drinking between the two groups: More frequent hangovers, abnormal physical conditions and higher KAST scores were seen in the normal group, and health examination showed higher values in liver function tests, including γ-GTP, and higher levels of blood pressure, HDL-cholesterol (HDL-C), etc., in the normal AlDH₂group.
It may be very useful for prevention of alcohol-related health disorders to help Mongoloid peoples, such as the Japanese, recognize whether their AlDH₂ is normal or deficient, which is as determined by the ethanol patch test.

SUMMARY OF EVENT: Bacterial, mycotic peritonitis and Candida fungemia developed in a patient with moderate ascites who had undergone endoscopic ultrasound-guided biliary drainage (EUS-BD). Antibiotics and antifungal agent were administered and ascites drainage was performed. Although the infection improved, the patient's general condition gradually deteriorated due to aggravation of the primary cancer and he died. TEACHING POINT: This is the first report to describe infectious peritonitis after EUS-BD. Ascites carries the potential risk of severe complications. As such, in patients with ascites, endoscopic retrograde cholangiopancreatography (ERCP) is typically preferred over EUS-BD or percutaneous drainage to prevent bile leakage. However, ERCP may not be possible in some patients with tumor invasion of the duodenum or with surgically altered anatomy. Thus, in patients with ascites who require EUS-BD, we recommend inserting the drainage tube percutaneously and draining the ascites before and after the intervention in order to prevent severe infection.
Anti-Bacterial Agents ; Ascites ; Bile ; Candida ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenum ; Endosonography ; Fungemia ; Humans ; Peritonitis

A woman in her 70s was referred to our hospital for epigastric pain. CT showed a 3-cm mass slightly below the cardia. At her request, we adopted a strategy of watchful waiting, but 2 years later CT and endoscopy revealed that the mass had grown to 3.5 cm, and single-incision laparoscopic intragastric resection was performed. The day after surgery, hematemesis was observed. Upper gastrointestinal endoscopy revealed oozing from the staple line at the tumor resection site, and hemostasis was performed. Oral intake was started on postoperative day 4, and the patient was discharged from the hospital on postoperative day 10. The final pathology results showed a low-risk gastrointestinal stromal tumor (GIST). Three years after surgery, there has been no evidence of passage obstruction or recurrence. We discuss the indications and techniques for single-incision laparoscopic intragastric resection and review the literature.

A woman in her late 80s visited a local physician complaining of nausea, loss of appetite, and constipation. She was referred to our hospital for detailed examination. Computed tomography (CT) revealed that the entire stomach, pancreas, spleen, transverse colon, and small intestine were prolapsed into the mediastinum and left thoracic cavity through the esophageal hiatus, which was dilated. Moreover, the small intestine was narrowed at the hiatus and dilated in the abdominal cavity, presenting ileus. After diagnosing type IV esophageal hiatal hernia with upside-down stomach and starting conservative treatment, the ileus improved and oral intake was resumed. Subsequent CT showed continued prolapse of the pancreas, spleen, transverse colon, small intestine, and entire stomach, but CT taken 5 years earlier had shown similar findings of prolapse. Thus, we decided not to perform surgery and instead opted for close follow-up after discharge. The patient is well without any symptoms of obstruction as of 1.5 years after discharge.