Shigeto Miyasaka

Advanced cancer with situs inversus totalis associated with KIF3 complex deficiency: Report of two cases

Situs inversus totalis (SIT) is a relatively rare congenital anomaly, occurring at an incidence of 1 in 10 000–50 000 live births. Although there are some case reports of SIT with the presence of cancer, there are few reports on the relationship between SIT and cancer. However, the recent phylogenetic investigations of this condition suggest that this may be linked to the development and progression of cancer on the molecular level. The key elements are one of the intracellular motor proteins, the KIF3 complex, and the cell-adhesion factors N-cadherin and β-catenin. We herein present the cases of advanced gastric cancer and lung cancer with SIT, and review the relationship between SIT and the development and progression of cancer.

Biphasic metaplastic sarcomatoid carcinoma of the breast: report of a case

A 69-year-old woman was admitted to our hospital with the complaint of a right breast mass. As a result of thorough examinations, she was diagnosed with breast cancer and underwent breast-conserving surgery. The pathological findings of the resected specimen showed that the tumor consisted of intermingled carcinomatous and sarcomatous components with a transition zone. On immunohistochemical study, the sarcomatous cells in this transition zone showed partial positive staining for CD10, the myoepithelial marker, suggesting that the myoepithelial cells had transformed into sarcoma, and then this biphasic tumor was formed. Finally, she was diagnosed with biphasic metaplastic sarcomatoid carcinoma of the breast. Biphasic metaplastic sarcomatoid carcinoma of the breast is a relatively rare but aggressive disease. The pathological diagnosis is often controversial, requiring detailed immunohistochemical analysis. We report our experience with a case of biphasic metaplastic sarcomatoid carcinoma of the breast.

Hemodynamic and Humoral Effects of Atrial Natriuretic Peptide on Pulmonary Circulation After Cardiac Surgery

PurposeHuman atrial natriuretic peptide (h-ANP) elicits biological effects such as natriuresis, diuresis, and vasodilation, and plays a role in regulating pulmonary circulation. We conducted this clinical study to define its role and elucidate its mechanisms.MethodsTwelve consecutive adult patients scheduled to undergo cardiac surgery with cardiopulmonary bypass (CPB) were prospectively selected for this study. After the completion of surgery, h-ANP was infused from the right atrium through a Swan-Ganz (S-G) catheter. Blood samples for measurement of ANP and cyclic guanosine monophosphate (cGMP), the second messenger of ANP, were drawn from the pulmonary artery (PA) through the S-G catheter and from the left atrium (LA) through the left atrial pressure line, before and after the infusion of h-ANP. Hemodynamic values were measured at the same time.ResultsAfter the h-ANP infusion, the plasma levels of ANP were significantly lower in the LA than in the PA, whereas the plasma levels of cGMP were significantly higher in the LA than in the PA. The infusion of h-ANP decreased the mean PA pressure significantly, and the systolic PA pressure remarkably.ConclusionThe infusion of h-ANP after cardiac surgery stimulates the secretion of cGMP from the pulmonary vascular bed and dilates the PA, thereby decreasing the PA pressure.

A case of acute arterial thrombosis caused by nephrotic syndrome.

Venous thromboembolic complications are frequently caused by nephrotic syndrome, while arterial thrombosis has rarely been reported. We report the successful treatment of a 53-year-old man who suffered from sudden severe pain of the left lower limb and facial edema. Abdominal computed tomography showed that the left common iliac artery was occluded from its origin. Although he had left peroneal nerve paralysis, thrombectomy and fasciotomy were performed for limb salvage. Renal biopsy revealed minimal change nephrotic syndrome after the operation. No recurrence has been observed. Nephrotic syndrome might be considered as a cause of acute arterial thrombosis.

A Case of Heparin-Induced Thrombocytopenia Type 2 after Repair of Juxtarenal Abdominal Aortic Aneurysm

Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF. As heparin-platelet factor 4 complex was positive, we diagnosed him with HIT and started argatroban while monitoring the activated clotting time (ACT), resulting in no further obstruction of the CHDF and an increase in the platelets. There was no disadvantage for administering nafamostat mesilate which we have commonly used instead of heparin, we should have used argatroban once we suspected HIT. It may be important to consider the history of heparin especially in administering heparin and it may be useful to monitor the ACT when initially starting argatroban for patients with HIT.

Delayed postoperative paraplegia and graft infection after a thoracoabdominal dissection.

WE REPORT THE SUCCESSFUL TREATMENT OF THORACOABDOMINAL DISSECTION, WHICH EXTENDED INTO THE LEFT ILIAC ARTERY, DESPITE TWO INDEPENDENT COMPLICATIONS: graft infection and a relatively rare, delayed postoperative paraplegia. The paraplegia suddenly occurred on postoperative day 10, and after an intravenous infusion of heparin and methylprednisolone, it gradually subsided. Moreover, graft infection was diagnosed on postoperative day 27, and with continuous irrigation of antibiotic treatment it was cured without recurrence of infection. Although anticoagulation therapy is not indicated for paraplegia, we suppose that it might be used as an adjunct therapeutic.

Vasculo-Behçet’s Disease that Began with Femoral Arterial Pseudoaneurysm Followed by Deep Venous Thrombosis: Report of a Case

Vasculo-Behçets disease mainly affects the venous system and central or peripheral arteries. It is often difficult to diagnosis this due to the complexity of symptoms and the rarity. A 35-year-old man with refractory inguinal lymphadenitis was admitted to our hospital. He was diagnosed with left femoral arterial pseudoaneurysm by enhanced CT scan of the lower legs, and we performed an emergency operation. Seven months postoperatively, he suddenly developed deep venous thrombosis, and then, symptoms such as aphthous stomatitis and pudendal ulcer started to develop progressively, complicating his uveitis. Finally, he was diagnosed with vasculo-Behçets disease.