Notes

Quantification of 16 polycyclic aromatic hydrocarbons throughout cigarette condensate using stable isotope dilution water chromatography with atmospheric-pressure photoionization combination mass spectrometry.
Management of breast cancer patients undergoing hemodialysis (HD) is difficult because of a lack of evidence about drug selection, dose adjustment, and surgical procedures. We herein present a case of metastatic breast cancer in a patient undergoing HD.

A 58-year-old Japanese woman with breast cancer undergoing HD underwent total mastectomy of the left breast and left axillary dissection. Histopathological examination revealed invasive ductal carcinoma, and the diagnosis was pT2N3cM0 Stage ⅢC. Immunostaining of the resected specimen indicated that the tumor was estrogen receptor-positive, progesterone receptor-negative, human epithelial growth factor receptor 2-positive, and the Ki-67 labeling index was 70%. A postoperative positron emission tomography/computed tomography (PET/CT) scan indicated fluorodeoxyglucose uptake in the supraclavicular nodes. She received adjuvant therapy of epirubicin and cyclophosphamide followed by docetaxel, trastuzumab (T-mab) and radiation therapy. However, she developed multiple liver metastases during adjuvant T-mab and hormone therapy. Therefore, her regimen was changed to trastuzumab emtansine (T-DM1) as first-line therapy, T-mab, pertuzumab (P-mab), and eribulin as second-line therapy, and T-mab, P-mab, and weekly paclitaxel as third-line therapy. Eventually, she was administered fourth-line treatment of T-mab, P-mab, and vinorelbine because of adverse events. She has survived more than 25 months after the initial detection of recurrence of breast cancer and maintained quality of life.

We report a case of breast cancer in a patient undergoing HD. It is very difficult to identify the appropriate drugs and dosages in patients undergoing HD to improve survival and quality of life.
We report a case of breast cancer in a patient undergoing HD. It is very difficult to identify the appropriate drugs and dosages in patients undergoing HD to improve survival and quality of life.
Hoffa fracture is a type of rare tangential supracondylar distal femoral fracture. The most common mechanism of this fracture injury is high energy trauma. In some cases, its poor visibility on X-rays makes its diagnosis difficult and needs more than routine X-rays. Treatment methods include conventional ORIF, or arthroscopy-assisted fixation as a more challenging method.

We present a case of a young female patient who sustained a low energy injury trauma to her left knee, which caused in a small minimally displaced lateral unicondylar Hoffa fracture.

Although it needs more experience and special tools, arthroscopy-assisted fixation of Hoffa fracture provides a good method of treatment, and it has many advantages over open method.

Our aim here is to confirm that Hoffa fracture may occur even with low energy knee trauma, and that arthroscopy-assisted fixation is a successful, applicable and alternative method to ORIF for small and thin osteochondral fragments, and could provide good stability and union even when using only one screw for fixation.
Our aim here is to confirm that Hoffa fracture may occur even with low energy knee trauma, and that arthroscopy-assisted fixation is a successful, applicable and alternative method to ORIF for small and thin osteochondral fragments, and could provide good stability and union even when using only one screw for fixation.
Plasmacytoma is a rare clonal neoplastic disorder of bone marrow that originates from plasma cells. It usually presents as a multiple myeloma (MM). Less than 5% of patients present with either a single bone lesion as a solitary bone plasmacytoma (SBP) or, even more rarely, as a soft tissue mass of monoclonal plasma cells representing a solitary extra medullary plasmacytoma (SEP).

We report a case of a 59-year-old man presenting with a mass of the soft palate evolving for a year. Physical examination showed an extension to the nasal cavity. Biopsy with immunohistochemical study demonstrated sheets of mononucleated plasmacytoid cells diffusely expressing CD138. The plasma cells showed monoclonal light chain Kappa. Further investigations did not show any other locations including bone and bone marrow. Thus, diagnosis of solitary extramedullary plasmacytoma of the soft palate was established. The patient was treated with chemotherapy with total remission on his one year follow-up.

SEP may arise in any organ, either as a primary tumor or as part of a MM. Almost 90% of SEP arise in the head and neck, especially in the upper respiratory tract. Primary treatment for most patients is radiotherapy, but surgery may also be required, and multidisciplinary decision between surgeon, hematologist and radiotherapist is crucial for planning optimum care.

SEP is an extremely rare condition which requires diagnostic and therapeutic management in the same level of MM. Prognosis is better than the two other forms (MM and SBP).
SEP is an extremely rare condition which requires diagnostic and therapeutic management in the same level of MM. Prognosis is better than the two other forms (MM and SBP).
The use of plates and screws for facial fractures is considered the gold standard; providing accurate reduction and rigid fixation.

We report on a case with multiple comminuted middle facial fractures and concurrent facial nerve injury. The fractures were fixed with a combination of interosseous dental wires and polypropylene sutures with a satisfactory outcome.

We aim to demonstrate two main advantages of wire/suture fixation in such cases when compared to plates and screws. Wire/suture fixation does not require periosteal dissection for fixation; and hence there is more preservation of the blood supply of the bony fragments. Furthermore, in the setting of concurrent facial nerve repair, the use of plates may risk re-injury of the repaired nerve during the late removal of the hardware. Selleckchem Necrostatin 2 Interosseous wires/sutures do not require late removal and this is another advantage in these cases.

Interosseous dental wires and polypropylene sutures may be considered for fixation of multiple comminuted middle facial fractures and concurrent facial nerve injury.
Interosseous dental wires and polypropylene sutures may be considered for fixation of multiple comminuted middle facial fractures and concurrent facial nerve injury.
The accepted indication for surgical removal of osteochondroma is when a lesion becomes symptomatic. There have been no established standard surgical approaches to remove osteochondroma on the first rib and no report on management after that. This report aims to present a novel approach by double clavicle osteotomy followed with internal fixation.

A 17-year-old female presented with a gradually enlarged bony mass with tenderness at the supraclavicular area. Radiographic images revealed a bony mass attached to the first rib. The provisional diagnosis is osteochondroma. The tumor was approached by osteotomy at the proximal and distal shaft of the clavicle. After removing the entire tumor, the direct reduction and internal fixation of the clavicle were performed.

Both, size of the mass and mobilization of the clavicle are factors in determining the surgical approach. Clavicular osteotomy, especially two sites, is considered when the lesion is extremely large. A possible complication after the clavicular osteotomy is nonunion or malunion. A proper technique of reduction and method of fixation contributes to reducing complications.

The double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.
The double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.
Many cases of unresectable cancer that cause obstructive jaundice require treatment. Depending on the patient's condition in these cases, surgery may be performed to treat jaundice. The main goal of palliative surgery is to improve the quality of life. Therefore, palliative surgery for obstructive jaundice must be performed safely and quickly.

This case presents a 45-year-old man with fever and back pain who was diagnosed with pancreatic head cancer and multiple liver metastases. Chemotherapy was initiated; however, during the course of treatment, the patient developed hemorrhage from pancreatic cancer that had invaded the duodenum caused hematemesis and melena. Therefore, the chemotherapy could not be continued. Because the patient also developed obstructive jaundice and cholangitis, a gastrojejunostomy and cholecyst-jejunostomy was performed. The surgery was successful; however, the cancer continued to progress, and patient died 31 days after surgery.

Biliary reconstruction can be difficult to perform safely and quickly due to many factors. This study shows that cholecyst-jejunostomy is effective for patients with end-stage cancer. In the long term, cholecyst-jejunostomy is not suitable for biliary reconstruction due to the possibility of bile congestion and cholecystitis. However, this easy and quick procedure is well indicated for emergency patients with a short life expectancy.

As an easy and quick procedure for emergency patients with a short life expectancy, jejunal anastomosis of the gallbladder is an appropriate palliative surgery that is indicated for jaundice treatment.
As an easy and quick procedure for emergency patients with a short life expectancy, jejunal anastomosis of the gallbladder is an appropriate palliative surgery that is indicated for jaundice treatment.
Blunt thoracic aortic injuries (BTAIs) are an uncommon traumatic injury that if not treated promptly, can result in death. We present the case of a BTAI with aberrant aortic anatomy.

A 60-year-old female was involved in a motor vehicle crash where she suffered significant polytrauma including a BTAI. She was also found to have an aberrant right subclavian artery originating from the aortic arch. Thoracic Endovascular Aortic Repair (TEVAR) with a right common carotid artery to right subclavian artery bypass was accomplished. She required three more vascular surgical interventions, two for persistent type II endoleak and the third for left upper extremity acute limb ischemia. She had a 2-month hospital course for her devastating injuries and was eventually discharged home. A follow-up CT angiogram showed a stable thoracic aortic arch stent.

BTAIs are uncommon in the trauma population. In our patient who had an aberrant right subclavian artery, further procedures were required in the form of a right commonnd mortality.
Walled off necrosis (WON) is clarified according to the revised Atlanta classification, 2013, as a late phase complication of acute necrotizing pancreatitis. Not all cases with WON need intervention but, if indicated both open approach and minimally invasive techniques were clarified. We are discussing here, a case presented to us with infected WON. We adopted the step up approach as the main line of treatment; the case was managed by percutaneous catheter drainage (PCD) followed by retroperitoneal necrosectomy using lavage circuit.

Diabetic male patient aged 58 year old gave to us with left hypochondrial pain accompanied with easy fatigability and poorly controlled DM. The patient had an attack of acute pancreatitis (AP) 2 months before admission. Abdominal CECT revealed infected WON. The case was managed successfully by retroperitoneal necrozectomy using lavage circuit after failure of PCD.

A step up approach is followed for determining the optimal interventional strategy for patients presented with infected necrosis.
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