Miwako Nozaki

Poor Neorectal Evacuation as a Cause of Impaired Defecatory Function After Low Anterior Resection: A Study Using Scintigraphic Assessment

AbstractPurpose. Patients who have undergone low anterior resection (LAR) of the rectum occasionally complain of symptoms related to impaired neorectal evacuation. Using scintigraphy, we assessed neorectal evacuation in 22 patients who underwent LAR and straight anastomosis, and correlated the results with clinical defecatory function, clinical factors, and anorectal manovolumetric parameters. Methods. After the introduction of an artificial stool containing 99mTc-DTPA into the neorectum, sequential lateral gamma images were obtained. From the time–activity curve of radioactivity in the whole pelvis, the time taken to eva-cuate half of the introduced artificial stool (T1/2) and the percentage of artificial stool evacuated in 1 min (Evac1) were calculated. Results. The Evac1 was significantly lower in the patients who had undergone LAR than in reference normal volunteers. A long T1/2 was significantly associated with worse defecatory function. The Evac1 was also significantly lower in patients with a low anastomosis. The rectal sensory threshold was significantly greater in patients with a shorter T1/2. The maximum tolerable volume of the neorectum was significantly greater in patients with a shorter T1/2 and a higher Evac1. Conclusion. Poor neorectal evacuation is associated with impaired defecatory function after LAR. Therefore, it is suggested that optimizing both reservoir function and evacuation of the neorectum would improve defecatory function after LAR.

Epidermoid cyst: rare testicular tumor in children

Epidermoid cyst of the testis, extremely rare in children, is a non-teratomatous benign tumor, and testis-sparing surgery should be the treatment of choice. To prevent unnecessary orchiectomy, recognition of this rare tumor in children is essential.

A Case Report of Long-term Survival after Radiotherapy for a Solitary Brain Metastasis from Breast Cancer.

This is the report of a patient with a solitary brain metastasis from breast cancer who survived more than 8 years after the first brain metastasis. The brain metastasis was treated with partial removal followed by 30 Gy/l5 fructions of whole brain irradiation plus 20 Gy/l0 fructions of local boost irradiation for 5 weeks. Brain metastases from breast cancer are usually a sign of rapid systemic tumor progression and long-term survivors are extremely rare. However, this case demonstrated the possibility of long-term survival in rare cases of brain metastases from breast cancer. This suggests a need for aggressive therapy in patients with a solitary brain metastasis.