Up to 1% of women with endometriosis develop endometriosis-associated neoplasms [1]. Most endometriosis-associated malignant tumors develop from the ovarian endometriomas, whereas those developing from extragonadal lesions are extremely rare, estimated at 0.2% [2]. Because they are uncommon, a treatment protocol for the malignant transformation of extragonadal endometriosis lesions has not been clearly defined. When the lesion is confined to the site of origin and R0 resection is achieved, the 5-year survival rate is between 82% and 100%; therefore, complete resection should be performed [3]. The patient in this video had previously undergone hysterectomy, bilateral salpingo-oophorectomy, left nephrectomy, and low-anterior resection of the rectum due to severe endometriosis. Ten years after the surgery, the patient had a 6 cm endometrioid adenocarcinoma developing from the residual endometriosis lesion at the left uterosacral ligament that involved the bladder, left ureter, and rectum. In this case, the tumor was attached to the pelvis due to infiltration of the left sacrospinous ligament. To completely remove the tumor, we used laterally extended endopelvic resection with abdominoperineal resection of the rectum. We used the laparoscopic-perineal-laparoscopic approach (pincer approach) because improved visualization of the left sacrospinous ligament increases the probability of achieving complete resection [4]. Pathological R0 resection was achieved without intraoperative or postoperative complications. Thus, for tumors that are firmly attached to the pelvic floor, the pincer approach can be useful for achieving R0 resection. The informed consent for use of this video was taken from the patient.

A woman in her 80s who had difficulty walking due to back pain was admitted to our hospital. Until two months earlier, she had been able to live independently in daily life. She was not severely constipated, did not take laxatives, and had not received an enema or undergone stool extraction. She had no abdominal symptoms, such as abdominal pain or distension. Surprisingly, however, computed tomography showed lower rectal perforation with subcutaneous emphysema in the pelvic retroperitoneum, hip, and left inguinal region. Therefore, we urgently performed abdominoperineal resection to save her. The lower rectum is a relatively uncommon site of perforation in the large intestine, and nontraumatic cases are rare. Elderly patients in particular may have only atypical symptoms and thus require careful attention.

Objective: We describe a case of lung cancer complicated with esophageal achalasia (EA), which was successfully treated with endoscopic pneumatic dilation (EPD). Case: A 66-year-old woman was admitted to our hospital because of frequent episodes of emesis and dysphagia after receiving an escalating dose of sustained release oxycodone (SRO) for cancer-related multifactorial back pain. She had been diagnosed with EA and treated with EPD at the age of 50. Her symptoms were refractory to the conventional anti-emetic agents such as prochlorperazine and metoclopramide. Computed tomography imaging showed marked dilatation of the esophagus with food residue. We diagnosed EA based on the presence of rosette-like esophageal folds on endoscopy and narrowing of the esophagogastric junction on esophagography, and subsequently performed EPD, which alleviated the symptoms. Discussion: The effects of opioids on esophageal motility have not been elucidated thus far. Recent studies using high-resolution manometry reported that long-term use of opioids was associated with esophageal dysmotility similar to that observed in EA. Although we have no evidence to directly demonstrate the causal relationship between the use of SRO and anti-emetic agents and EA, we speculate that our patient’s symptoms might be associated not only with SRO-related emesis during the gradual worsening of EA, but also partly with the SRO-induced esophageal dysmotility and the constrictive effect of dopamine D₂ receptor antagonists on the lower esophageal sphincter. Care must be taken to avoid drug-induced esophageal motor dysfunction, which might lead to deteriorate EA.

　　This paper reports three cases of malignant afferent loop obstruction after choledochojejunostomy. In the first case, a 75-year old woman, who had undergone left hepatectomy for bile duct cancer with bile duct resection, was admitted for Roux en Y reconstruction after choledochojejunostomy because of emesis. The local recurrent tumor caused occlusion of the duodenum and afferent limb, and bypass surgery was performed after transintestinal drainage. In the second case, a 57-year-old man, who had undergone pancreaticoduodenectomy for pancreas cancer, was hospitalized with a high-grade fever and epigastric pain. Exploratory laparotomy revealed widespread carcinomatosis causing afferent loop obstruction, and bypass surgery was performed. In the third case, a 60-year-old woman with paraaortic lymphnode recurrence of gallbladder cancer was admitted as she had afferent loop syndrome. Transintestinal drainage was performed. All these three patients were discharged. Bypass surgery for selective patients turned out to be an effective palliative treatment for malignant afferent loop obstruction.

Background: The Objective Structured Clinical Examination （OSCE）–Reflection Method （OSCE-R）, a version of the OSCE for training physical therapists which incorporates group reflection through video, has been developed and implemented in our study. The purpose of this research was to introduce the OSCE-R to the second-year students and to examine its effects on learning.
Method: The subjects were 91 second-year students of the physical therapy department of our university. Before and after group reflection, OSCE score comparison, reflection sheet analysis, a questionnaire survey, and interview investigation were performed.
Results and Discussion: The OSCE scores increased significantly, and students learned the importance of reflection and empathy with patients. The combination of theory and clinical practice helped students to actively learn while crossing boundaries between school and hospital.

PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Aged ; Disseminated Intravascular Coagulation/complications/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Sepsis/complications/diagnosis/*drug therapy ; Time Factors ; Treatment Outcome

  Our palliative care team intervened in a patient with sciatica resulting from metastasis to sacral bone after surgery for rectal cancer. Rapid pain control and a change in the route of rescue drug administration from the stoma were needed. Partial opioid rotation was performed. The dose of 25.2 mg in 72 hours in a transdermal fentanyl patch decreased to 16.8 mg in 72 hours, and the dose of 3.6mg in an hour by continuous intravenous injection of morphine was added. The change in the rescue root to intravenous administration by a patient-controlled analgesia pump gave the patient relief from his pain. He was able to attend his daughter's wedding. His family were all pleased with the relief provided. The advantages of this partial opioid rotation are summed up in the following three points: (1) The required time is relatively short; (2) It can be expedient for analgesia due to the addition of different opioids; and (3) The partial opioid rotation produces fewer adverse effects than a full opioid rotation. Adjustment of the amount of drugs for pain relief in cancer patients is important with the situations of the patient and the family taken into consideration fully.

A 62-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to undergo cardiac surgery for aortic stenosis, angina pectoris, and paroxysmal atrial fibrillation. A bleeding tendency was expected due to the dramatic decrease in platelets during cardiopulmonary bypass. We performed high-dose transvenous gammaglobulin infusion (400mg/kg/day) for 5 consecutive days immediately before surgery. The gammaglobulin therapy caused steady increase of thrombocytes from 4 days after surgery, even though the platelet count showed no significant change preoperatively. The postoperative course was satisfactory with neither a bleeding tendency nor wound infection. High-dose transvenous gammaglobulin therapy is thus useful for perioperative patients with accompanying ITP, who are often under medication with steroids. This therapy is also effective for prevention of infection.

From a point of stress, the competitive sports are totally different from exercises for the health promotion. It would be even harmful especially for middle-distance or long-distance women runner. It brings them paramenia, defatigation and other orthopedic troubles which makes them unable to exercise further more.We have investigated the possibility of the preventive use of Kampo Medicine for those athletes and found that it is useful. The nine women who belong to the Tohoku-Region women team of long-distance relay road race had received Kampo medical treatment for 7 months. Serum CPK and AST were elevated with training exercise. In the cases whose CPK level was above 500 IU/l, most of them suffered from fatigue, leg pain, low back pain, and lower abdominal pain, which is very important for Kampo diagnosis. Because these symptoms unable athletes to exercise as planned, we understand that for the improvement of physical capacity, it is important to prevent those symptoms. For the treatment and prevention of the symptoms, we prescribed Keishibukuryogan, Rikkunshito, and Shimotsuto. We defined preventive medication period as “Mibyou” and continued to use Kampo medicine for 7 months. During the period, they were free from any troubles that would make them unable to exercise. These medicines enabled them to improve their records drastically. This study shows that preventive use of Kampo Medicine is extremely effective for any athletes to maintain their good conditions.
Medicine, Kampo ; athlete ; Exercise ; symptoms <1> ; Human Females

Human β-defensin (hBD) 2 is an epithelial antimicrobial peptide. We studied single-nucleotide polymorphisms in the gene of hBD-2 in a Japanese population, and estimated the effect of a polymorphism in the promoter/enhancer region on the transcriptional activity. By sequencing the hBD-2 gene of 50 unrelated individuals, we detected one SNP in exon 2 and nine SNPs in the promoter/enhancer region. The SNP in the coding region at the +1765 position is synonymous [CCC (Pre)→CCT (Pre)]. One SNP in the promoter region (-1029) is located at the consensus sequence for NF-IL6 binding. By luciferase reporter assay and electrophoretic mobility shift assay, the wild-type (G) of -1029 showed significantly lower transcriptional activity than did the variant-type (A). The SNP at position -1029 may influence the hBD-2 expression and cause genetic variations in susceptibility to infectious diseases.