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Maeda O.,Meijo Hospital | Moritani S.,Nagoya Medical Center | Ichihara S.,Nagoya Medical Center | Inoue T.,Kishokai Medical Corporation | And 7 more authors.
Journal of Medical Case Reports | Year: 2015

Introduction: Low-grade endometrial stromal sarcoma is very rare and difficult to diagnose in the early stage. A standard treatment has not been established. In this case report of a patient with long-term survival, we describe an effective treatment for advanced low-grade endometrial stromal sarcoma. Case presentation: A 24-year-old Japanese woman who presented with prolonged menstruation was diagnosed with leiomyoma on the basis of a specimen resected transvaginally. She underwent ten resections in 10 years without a malignancy diagnosis. During this period, she gave birth. At age 34 years, she visited our hospital, complaining of lower abdominal pain. A 10cm tumor was detected behind her uterus. The disease was diagnosed as an advanced malignant ovarian tumor before surgery. A laparotomy was performed, with many remnants left in the abdominal cavity. The final diagnosis was advanced low-grade endometrial stromal sarcoma. After 12 cycles of gemcitabine and docetaxel combination chemotherapy, the tumor disappeared completely. A retrospective pathological review of the specimens resected transvaginally showed that the tumors included low-grade endometrial stromal sarcoma elements. When the patient was age 42 years, the sarcoma recurred. It was detected around the right diaphragm and liver. Despite administration of gemcitabine and docetaxel, ascites and pleural effusion accumulated. Administration of medroxyprogesterone acetate, leuprorelin acetate, and anastrozole gradually reduced the ascites and pleural effusion. In addition to the three hormone drugs, 18 cycles of paclitaxel and carboplatin were administered. The patient recovered from her critically ill state and is currently alive with reduced tumor at age 45 years. Conclusions: Our patient with low-grade endometrial stromal sarcoma whose disease began in her youth gave birth and experienced long-term survival with surgery, chemotherapy, and hormone therapy. © 2015 Maeda et al.

Hara M.,Inazawa Municipal Hospital
Japanese Journal of Neurosurgery | Year: 2015

Spinal fusion is a familiar surgical technique; however, the concept of spinal fixation is different when applied in the cervical spine compared with in the thoracic and lumbar spine. Although the fusion procedure is most often performed to treat the instability and deformity in the thoracic and lumbar spine, cervical fusion is frequently performed in cases without instability and deformity. Anterior cervical decompression and fusion is a typical fixation procedure. In accordance with cervical spinal pathology, we should select anterior or posterior surgery and fusion or non-fusion surgery. If the pathology exists in 2 or less intervertebral lesions, an anterior decompression and fusion procedure is often performed, whereas posterior decompression surgery is frequently selected for cases involving 3 or more intervertebral lesions without instability. We describe the indications divided into absolute and relative indications, surgical methods, complications and surgical tips of cervical fixation. © 2015, Japanese Congress of Neurological Surgeons. All rights reserved.

Hara M.,Inazawa Municipal Hospital | Nishimura Y.,Nagoya University | Nakajima Y.,Inazawa Municipal Hospital | Umebayashi D.,Nagoya University | And 4 more authors.
Neurologia Medico-Chirurgica | Year: 2015

Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the miniopen TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies. © 2015, Japan Neurosurgical Society. All rights reserved.

Takefuji S.,Inazawa Municipal Hospital | Nakajima S.,Inazawa Municipal Hospital | Shibata M.,Inazawa Municipal Hospital | Itoh M.,Inazawa Municipal Hospital | And 4 more authors.
Journal of the Japan Diabetes Society | Year: 2015

The patient was a 60-year-old Japanese man with chronic alcoholism who presented with lower limb edema, abdominal distension and hyperglycemia(plasma glucose, 501 mg/dl;HbA1c, 9.2 %). A diagnosis of diabetes mellitus with liver cirrhosis was made and insulin therapy (48-64 IU/day) was started in 2010. For half a year the patient was under good diabetic control, however, his condition deteriorated (FPG; 408 mg/dl and HbA1c; 11.5 %). He was admitted with portal hypertension and Hassabs' surgery was performed in 2011. Following surgery, he made a recovery from portal hypertension and an improvement was observed in his diabetic-control. His glucose intolerance improved and insulin therapy was discontinued. He was discharged under good diabetic control (HbA1c; 5.5 %) with glimepiride treatment (0.5 mg/day). The glimepiride treatment was eventually ceased. We hope this case report will help some readers treat patients with portal hypertension and insulin-resistant diabetes mellitus more effectively.

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