We performed gamma knife treatment for multiple brain metastases including a left frontal lobe lesion in a patient in his 60s who had renal cell carcinoma. After treatment, the left frontal lobe lesion initially shrank but then began to grow again, resulting in extensive edema, right hemiparesis, impaired activities of daily living (ADL), and decreased motivation. Although the renal cell carcinoma was in the terminal stage, we judged that recovery of ADL could be expected by removing the left frontal lobe lesion and therefore performed craniotomy tumor removal. As a result, the patient’s motivation and right hemiplegia markedly improved and ADL dramatically improved. Although the period from craniotomy tumor removal to death was as short as 2 months, significant improvement of ADL during this time was achieved by removing the tumor. Tumor resection for metastatic brain tumors is rarely performed in the setting of end-stage cancer. However, this case highlights the potential of brain tumor resection as palliative treatment that can be considered for improving ADL even in patients with terminal cancer.

PURPOSE: Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. MATERIALS AND METHODS: Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. RESULTS: Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). CONCLUSION: TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.
Asian Continental Ancestry Group ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Emergencies ; Humans ; Propensity Score ; Retrospective Studies

Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.

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*

  A large number of patients are treated in various countries with the traditional radon spa therapy. Adequate oxygen stress induced by radon inhalation activates chemical biological protective functions, such as induction of the synthesis of superoxide dismutase (SOD) and glutathione peroxidase. We previously reported that radon inhalation elevated antioxidant enzymes in patients with bronchial asthma and osteoarthritis 1), 2). Objectives: Although many clinical studies have been reported, the reason why radon inhalation results in positive effects is still unclear. To elucidate the probability that activation of chemical biological protective functions alleviates various oxidation injuries, we studied the mechanisms of the effects of radon using small animals. Methods: To examine whether radon inhalation activates antioxidative functions in mice, we developed a new facility for exposing small animals to radon and examined SOD activity, which is an antioxidative enzyme, in plasma, liver, pancreas, heart, thymus, kidney, brain, small intestine, lung, and stomach of mice. Mice were exposed to radon at a concentration of 250, 500, 1000, 2000, or 4000 Bq/m3 for 0.5, 1, 2, 4, or 8 days. Results: It was shown that continuous exposure to radon increases SOD activity in most organs of mouse. In addition, our data suggested some new indications for radon treatment3). Next, we assessed whether radon inhalation provided protection from carbon tetrachloride (CCl4)-induced hepatic and renal damage in mice. Results showed that radon inhalation inhibited CCl4-induced hepatic and renal damage in mice due to activation of antioxidative functions in liver and kidney4). Although hepatic and renal damage are not the main indication for radon therapy, radon inhalation mitigates liver and kidney damage due to activation of antioxidative functions in liver and kidney. This antioxidative effect against CCl4-induced hepatopathy is comparable to treatment with ascorbic acid (vitamin C) at a dose of 500 mg/kg weight or α-tocopherol (vitamin E) treatment at a dose of 300 mg/kg weight and is due to activation of antioxidative functions5). We also suggested radon inhalation inhibits streptozotocin (STZ)-induced type I diabetes in mice due to activation of antioxidative functions in pancreas. Conclusion: Thus, radon inhalation very likely activates the defense systems in the body, and therefore, contributes to preventing or reducing reactive oxygen species (ROS)-related injuries, which are thought to involve peroxidation.