Kazutoyo Shirakawa

Familial Epidermoid Cysts of the Spleen : Report of Two Cases

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patients 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 × 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.

Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial

The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy recovery after colorectal resection.

A case of metachronous brain metastases from gastric cancer with no recurrence

症例は75歳の男性で, 急性骨髄性白血病のため当院血液内科で化学療法を受け, 完全寛解状態であった. 今回, 貧血の精査のため行った上部消化管内視鏡検査にて胃体上部に進行胃癌を指摘され, D2郭清を伴う胃全摘術を施行した. 術後1年5か月目に人格変化, 嘔吐がみられ, 頭部MRIを施行したところ, 大脳半球に3個の転移性脳腫瘍を認めた. 胸腹部CT, 腹部超音波検査では転移を認めず, 腫瘍マーカーも正常であった. 白血病再燃による病変も否定できず, 脳腫瘍生検を行った. 病理組織学的診断は中分化型腺癌で, 胃癌の病理組織学的検査所見とも一致しており, 胃癌脳転移と診断した. 脳転移に対し, サイバーナイフを行ったところ, 臨床症状の改善を認め, 通院治療が可能となった. 5か月後, 新たな2個の脳転移に対し, 再度サイバーナイフの施行を要したが, 脳転移発症後1年経過現在, 胸腹部を含め無再発生存中である.