A 26-year-old woman was referred to our hospital with a high fever and thrombocytopenia. The patient was initially given a diagnosis of disseminated intravascular coagulopathy and sepsis. Medial therapy with antibiotic and anticoagulative drug was started in the Department of Internal Medicine. After that, dermatologists identified painful nodular erythema on the face and extremities as Osler's nodes. Echocardiogram revealed a vegetation near the annulus of the mitral valve. The urgent operation was performed. Intraoperative findings showed vegetation on the posterior wall of the left atrium and normal mitral valves. Therefore, vegetation was completely excised with the diseased left atrial wall and the mitral valve was preserved. The defect of the atrial wall was repaired with a pericardial patch. Methicillin-resistant Staphylococcus aureus was detected by blood and tissue bacterial culture. Postoperative echocardiograms showed mild mitral regurgitation. The patient was discharged from hospital after an uneventful postoperative course.

A 73-year-old man presented with gastric adenocarcinoma 14 months after coronary artery bypass grafting with an in situ right gastroepiploic artery (RGEA) to left circumflex branch (LCx). He underwent a partial gastrectomy after successful percutaneous coronary intervention (PCI) to the occluded lesion of LCx. Though the RGEA graft was injured and sacrificed intraoperatively, gastrectomy was safely accomplished without any complication and the postoperative course was uneventful. Preoperative PCI was useful for a gastrectomy in a patient with an in situ RGEA.

Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155.
Anastomotic Leak ; Asian Continental Ancestry Group ; Conversion to Open Surgery ; Gastrectomy* ; Humans ; Japan* ; Laparoscopy ; Medical Oncology* ; Non-Randomized Controlled Trials as Topic ; Prospective Studies ; Stomach Neoplasms*