Notes

COVID-19: Exactly where would be the Nigerian cultural employees?
Snowballing comorbidity load doesn't get worse benefits throughout management of continual rhinosinusitis.
Association in between cholesterol intake and all-cause mortality: NHANES-linked fatality rate study.
There was a difference in consciousness among doctors regarding the timing of switching from second- line to third-line chemotherapy and the timing of switching from nivolumab to fourth-line therapy.A 65-year-old man was emergently brought to our hospital because of rupture of 10 cm hepatocellular carcinoma(HCC) at left lobe in September 2019. He underwent selective transcatheter arterial embolization(TAE)for hemostasis. Enhanced computed tomography(CT)revealed one more 26 mm HCC at segment 8(S8)in addition to the ruptured HCC. Transcatheter arterial chemoembolization(TACE)was performed for both tumors. HCC at left lobe was resistant to TACE, hence we performed left hepatectomy. During the surgery we searched for peritoneal dissemination by using indocyanine green(ICG) fluorography and found 4 nodules with ICG accumulation in the omentum. All the nodules were pathologically diagnosed as peritoneal dissemination. We reported a case in which the ICG fluorography was very useful for detecting small peritoneal disseminations.
To review the clinical features of the patient with cystic pulmonary light chain deposition disease(LCDD)and record high-resolution CT and histopathological findings.

A 60-year-old woman who diagnosed multiple myeloma was admitted. There were diffuse proliferation of plasma cells by the bone marrow puncture that she received. And multiple cystic pulmonary tumors found in CT. We analyzed the method and result of the diagnosis. CT showed multiple cystic pulmonary tumors in the both lung which vessels traversing the cysts with thin wall ranged 5 to 30 millimeters. There were no abnormality in the heart, kidney and liver. Right upper lobe wedge resection was performed via video-assisted thoracic surgery( VATS)to establish a definitive diagnosis. Thoracoscopic findings revealed multiple white oval formed tumors in the visceral pleura. Histological HE staining findings of the surgical specimen revealed amyloid-like acidophilic material, and the immunohistochemical Congo red staining revealed monoclonal IgG with a kappa component. link= TGF-beta inhibitor clinical trial According to the above results these tumors had a diagnosis of pulmonary LCDD.

VATS was effective to diagnose pulmonary LCDD in multiple cysts formation.
VATS was effective to diagnose pulmonary LCDD in multiple cysts formation.We report a case of long-term survival in a 75-year-old male with advanced gastric cancer and Virchow's lymph node metastasis[cT3N3M1(LYM)H0P0, cStage Ⅳ]which received multidisciplinary treatment. TGF-beta inhibitor clinical trial Over 1 year and 6 months, 5 courses of S-1 plus CDDP, 14 courses of S-1 plus docetaxel, and 3 courses of S-1 plus CPT-11 were administered. Following chemotherapy, FDG-PET/CT showed FDG uptake only in the primary tumor and regional lymph nodes. Total gastrectomy and D2 dissection were performed. The pathological diagnosis was Type 5, 55×50 mm, L, Less, tub1>tub2, T3, int, INF b, ly2, v1, pPM0, pDM0, pN2(3/29), HER2(-). S-1 was used as adjuvant chemotherapy. Four years and 7 months after resection, cervical lymph node swelling was detected. link2 The cervical lymph node was resected, followed by radiotherapy administration(56 Gy/28 Fr). No relapse occurred, and the patient has survived more than 7 years and 1 month and 8 years and 11 months after conversion surgery and diagnosis, respectively.A 56-year-old man presented at a local hospital with nausea, vomiting, epigastric pain, and white stool. CT scan showed hypovascular mass in pancreatic uncinate process and multiple peritoneal nodules. The diagnosis was stage Ⅳ pancreatic cancer(unresectable), and the patient underwent chemotherapy with GEM plus nab-PTX. He also claimed a severe cancer pain at presentation and was prescribed oxycodone 60 mg/day. link2 After 43 months of chemotherapy, the duodenum was obstructed by tumor growth on CT scan, then he underwent duodenal stent placement. He eventually needed a total of 3 duodenal stenting for re-obstruction. He could keep adequate oral intake after the treatment. He also suffered from severe pain by progressed tumor, then underwent celiac plexus block and palliative radiation therapy(20 Gy/5 Fr). Afterwards his cancer pain has been under control. He underwent chemotherapy with FOLFIRINOX for next step. A patient with stage Ⅳ pancreatic cancer may survive for a long period with adequate QOL as a result of multidisciplinary treatment.The patient was 54 years old, female. She was aware of gradually worsening right peri-eyelid swelling 2 years before the first presentation to our dermatology department. She underwent biopsy of eyelid skin 2 times. Nevertheless, definitive diagnosis was not obtained. Two months after the initial examination, right anterior thoracic swelling appeared, and right axillary, right subclavian, and interpectoral lymphadenopathy were detected. She was referred to our department for diagnosing metastatic breast cancer. TGF-beta inhibitor clinical trial Ultrasonography showed hypoechoic lesion with distortion(largest lesion>2 cm)in right breast, which was suspected to be a breast cancer. The results of breast core needle biopsy, the third time's eyelid skin biopsy and additional imaging studies confirmed T2N3M1, Stage Ⅳ right mammary invasive lobular carcinoma with metastasis to the eyelid skin, right axillary lymph nodes, right subclavian lymph nodes and the subcutaneous tissue of the right back. Immunohistochemical studies showed ER-positive, PgR-negative, HER2-negative, and low Ki-67 expression. Endocrine therapy with letrozole was initiated, which maintained stable disease without compromising the quality of life.A 46-year-old woman with metastatic breast cancer developed dyspnea that progressed relatively rapidly during chemotherapy. Chest-abdominal CT revealed wedge-shaped infiltration shadow, and cardiac catheterization revealed elevated pulmonary artery pressure. Aspiration cytology of pulmonary arterial blood was performed and malignant cells were confirmed. Chemotherapy was difficult to continue because of deterioration in general condition, and she died 7 days after diagnosis. This time, we report a case of PTTM for which pulmonary arterial blood cytology was useful for diagnosis.Patients with cancerous ascites often manifest with various symptoms, such as abdominal distension and poor appetite. Ascites puncture may offer temporary relief, but there is a consentration loss of important proteins, such as albumin and immunoglobulin. Cell-free and concentrated ascites reinfusion therapy(CART)is helpful to compensate for this loss of proteins. However, the volume of ascites that can be retrieved is small, and patients occasionally have high fever at the time of reinjection. CART modified by Keisuke Matsusaki(KM-CART)is an improved version of CART with respect to these points. We performed KM-CART for a woman with breast cancer with ascites arising from peritoneal dissemination, and she had a good QOL until she died. We hope that more patients will benefit from KM-CART.We investigated the efficacy of colonic stent as a bridge to surgery(BTS)for malignant colonic obstruction retrospectively. 25 patients were inserted self-expandable metallic colonic stent as BTS(S group), 16 patients were placed trans-anal ileus tube as BTS(I group)and in 15 patients(E group)emergent surgery were performed. These 3 groups were investigated as follows. Technical success for colonic stent placement was obtained in all S group patients but clinical success rate was 92.0%(23/25). One was not decompressed sufficiently due to 2 obstructed colonic cancers and another patient stent was migrated. 3-year overall survival was 79.7%(S group), 75.0%(I group), 73.3%(E group), respectively. 3-year progression- free survival was 47.1%, 56.3%, 53.3%, respectively. Overall survival rate for S group patients was equivalent compared with patients of non-obstructive colonic cancer(control group)in stage Ⅱ/Ⅲ for the same investigation periods. Colonic stent for BTS was indicated to be safe and effective strategy for obstructive colon cancer, and further investigation are needed to confirm long-term outcomes.A 50-year-old woman was admitted to our hospital due to intermittent epigastric pain and vomiting for 2 months. Contrast enhanced CT scan showed stenosis in the upper jejunum. She was diagnosed with small intestinal ileus. A small enteroscopy revealed a peripheral type 2 lesion in the upper jejunum, approximately 10 cm from the Treitz's ligament. Upon biopsy, she was diagnosed with a well-differentiated adenocarcinoma. A laparoscope-assisted extracorporeal operation was performed due to the ease of raising the umbilical wound. Swollen lymph nodes were found in the mesentery. A surgical margin of 5 cm on the oral side and 20 cm on the anal side was secured. We performed partial resection of the small intestine, including the mesentery with the enlarged lymph nodes. The histopathological diagnosis was a Type 2, 3×2 cm, tub2, pT4aN1aM0, pStage Ⅲb small intestinal cancer. link3 Due to the development of small intestinal ileus, the small bowel cancer was diagnosed preoperatively. Hence, it was slightly we will report including the literature consideration of.
Cystine and theanine are amino acids that contribute to the production of glutathione, which is the most potent antioxidant in the body, and it has been reported that these amino acids prevent immunosuppression, has anti- inflammatory effect, and reduce invasiveness.

To evaluate the effect of oral administration of amino acids cystine and theanine on stomatitis during chemotherapy.

For 17 patients with Grade 1(CTCAE v4.0)or worse stomatitis during chemotherapy for gastrointestinal cancer or breast cancer, cystine 700 mg and theanine 280 mg/ day were orally administered for 28 days, and the degree of stomatitis was evaluated objectively and subjectively.

As an objective evaluation, changes in Grade showed improvement in 11 cases(64.7%), 5 cases unchanged(29.4%), and 1 case was worse(5.9%). Subjective assessment, pain was in remission(30.8%)or disappeared(61.5%)in 4 of 13 cases. Food intake increased in 5 patients(29.4%). 15 of 17 patients(88.2%)felt it was effective.

Oral administration of amino acids cystine and theanine during chemotherapy can reduce the symptoms of stomatitis.
Oral administration of amino acids cystine and theanine during chemotherapy can reduce the symptoms of stomatitis.Phyllodes tumor is a rare interstitial and epithelial mixed tumor which constitutes 0.3-0.9% of all breast tumors. It is classified into benign, borderline malignant, and malignant. Differentiating this from fibroadenoma is difficult, however, when diagnosed, complete surgical resection is recommended. Patients and results Forty-four patients who underwent surgery between April 2009 and April 2020 and were diagnosed with phyllodes tumors and the median observation period was 44 months. The average tumor diameter was 39.2 mm, and the surgical procedures performed were mastectomy in 3 cases, partial resection in 26 cases, and extirpation in 15 cases. link3 The surgical margin was positive in 6 cases. Intra-breast recurrence occurred in 4 cases, of which the initial surgery in 3 cases was extirpation. The pathological diagnosis was malignant in 4 cases, malignant in 15 cases, and benign in 25 cases. Conclusion In this study, intra-breast recurrence occurred in many cases treated by extirpation, and it was considered that the surgical technique for complete resection such as partial resection should be selected.
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