A case of testicular cancer in a long-term hydranencephaly survivor with undescended testes

Introduction

The development of malignant tumors in patients with hydranencephaly is extremely rare. We describe the first case of testicular cancer that developed in the undescended testes of a long-term survivor of hydranencephaly.

Case presentation

A 32-year-old man with severe cerebral palsy due to hydranencephaly was referred to our department for the evaluation of a subcutaneous lump in the lower right abdomen. He was a long-term survivor of hydranencephaly. After confirming the diagnosis of right testicular cancer originating in his undescended testes, surgical resection was performed. Pathological examination revealed a mixed-type germ cell tumor.

Conclusion

The decision-making process for treating malignant tumors, like testicular cancer, in adults with severe cerebral palsy can be challenging. Clinical ethics consultation could be helpful in avoiding treatment delays.

Quantifying the Occurrence of Shoulder Pain after Cardiac Surgery in a Cardiac Rehabilitation Population

Purpose: The aim of this study was to identify the occurrence of shoulder pain after cardiac surgery among cardiac rehabilitation participants (CRPs) and its interaction with cardiac rehabilitation (CR). Method: This was a cross-sectional questionnaire-based study of open-heart surgery patients conducted at the midpoint of a 6-month CR programme. We measured the proportion of patients experiencing shoulder pain, onset, location, impact on rehabilitation, and pain and disability using the Shoulder Pain and Disability Index. Results: Of 70 (76% men) CRPs, 47% (33) reported shoulder pain post-surgery, with most (91%; 29 of 32) remaining symptomatic at the time of questionnaire completion, 14.6 (SD 37.9) months post-surgery. Disability and pain scores were 4.2 (SD 2.8) and 5.7 (SD 2.5), respectively (maximum score 10). Of people with shoulder pain participating in resistance training (RT; 19), 8 (42%) reported it was beneficial for shoulder pain; 7 (37%), no effect or unknown; and 4 (21%), some aggravation. Modifications to RT by programme staff were reported by 47% (8) of participants. Of those with shoulder pain, 10 (31%) reported some benefit; 20 (63%), no effect or unknown; and 2 (6%), aggravation from aerobic training. Conclusions: Almost half of the CRPs who had undergone open-heart surgery reported moderately severe and disabling shoulder pain that persisted for at least 14.6 (SD 37.9) months. Almost half the RT participants were prescribed exercise modifications with few negative effects. Shoulder pain is a significant issue after surgery, and appropriate screening is recommended for safe CR participation.

Uterine intravenous leiomyomatosis with an isolated large metastasis to the right atrium: a case report

Background

An intravenous leiomyomatosis is a special type of uterine leiomyoma characterized by the formation of benign leiomyomatous tissue within the vascular wall. Although histologically benign, intracardiac metastasis can lead to circulatory failure, and death, if untreated. Herein, we report on a case of a uterine intravenous leiomyomatosis with an isolated large adherent metastasis in the right atrium of the heart.

Case Presentation

A 52-year-old Japanese woman sought medical attention at our hospital for lower abdominal pain. A 27-cm uterine mass was detected on clinical imaging, with a 78 × 47-mm mass in the right atrium detected on preoperative echocardiography. Intracardiac mass resection and tricuspid annuloplasty were performed as the first-stage surgery. The pedicle of the tumor was adherent to the wall of the atrium. On histological examination, the tumor was found to consist of spindle-shaped cells with eosinophilic cytoplasm, without atypia, but with a myxoid change, and rich microvascularization of the pedicle. Total abdominal hysterectomy was performed as the second-stage surgery, with confirmation of the diagnosis as uterine intravenous leiomyomatosis with an isolated metastasic lesion to the right atrium. There has been no evidence of tumor recurrence in the 15 months since surgery.

Conclusion

We report a unique case in which a large right atrial leiomyoma was identified following a uterine intravenous leiomyomatosis. Our case exemplifies that intravenous leiomyomatosis metastatic tumors have the potential to grow via their vascularization.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model

PURPOSE

To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches.

DESIGN

The study used qualitative methods comprising semistructured interviews and focus groups.

SETTING

The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario.

PARTICIPANTS

Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults.

METHODS

Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data.

RESULTS

Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches.

CONCLUSION

The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

[The clinical effect of low-dose FP (5-FU + low-dose CDDP) in patients with far advanced gastric cancer, and their quality of life]

Low-dose FP therapy was carried out in 30 patients with far advanced gastric cancer and assessed according to anti-tumor effect and quality of life (QOL). This therapy consisted of CDDP (3.5-7 mg/m2/day infused on Days 1-5 every week) and continuous infusion of 5-FU (250 mg/m2/day for 28 days). A partial response was observed in 15 cases, so the overall response rate was 50%. The response rates with stomach and lymph node cancers were higher than those of other organs (64.3% and 55.6%). Patients without peritoneal dissemination, with good performance status (PS) (0, 1) and differentiated histologic type showed a significantly higher response rate than patients with peritoneal dissemination, poor PS (2, 3, 4) and undifferentiated histologic type (p = 0.0034, 0.0253, 0.0080). No side effects (> or = WHO grade 3) were observed. The QOL of patients was assessed according to the percentage of patients with an observed improvement of diet, who could be discharged from hospital, and the duration in hospitals in relation to survival time (hospital stay). The QOL of patients with low-dose FP therapy was better than that of patients with usual combination chemotherapy. Low-dose FP therapy is a promising regimen for patients with far advanced gastric cancer.

[Binding of K-18 on the surface of tumor cells--flowcytometrical analysis in vitro]

After K-18 was contacted with various kinds of tumor cell lines in vitro, the binding pattern was examined. K-18 bound on the surface of K-562 cells showed the maximum levels 1 hr later and maintained the binding activity for 24 hrs in the analysis by flowcytometry. K-18 also bound to HeLa S3, KB, RPMI8226, P815, YAC-1 and L1210 cells. Fluorescent intensity on K-562 cells was stronger with whole molecules of K-18 than with F(ab')2 conjugated with melphalan. Normal human IgG could bind more on the surface of K-562 cells than F(ab')2 of IgG. These results suggest that K-18 might bind on tumor cells via IgG Fc receptors on their surface.

Treatment of malignant ascites and pleurisy by a streptococcal preparation OK-432 with fresh frozen plasma--a mechanism of polymorphonuclear leukocyte (PMN) accumulation

A single injection of a streptococcal preparation, OK-432, with fresh frozen plasma (FFP) (or fresh human serum) into the peritoneal or pleural cavity for the treatment of malignant ascites or pleurisy resulted in a complete reduction of ascitic fluid or pleural effusion in 5 out of 11 patients. FFP was used a further source of complement for the effective accumulation of antitumor polymorphonuclear leukocytes (PMNs) by complement-derived chemotactic factors in the cavity. C5a increased in the fluids 3-9 h after the injection and preceded a massive increase in PMNs. C1 inhibitor (C1INH) and C3b inactivator (C3bINA) decreased in several cases 6 h after the treatment. Chemotactic arachidonic acid metabolites, thromboxane B2(TXB2) as a characteristics of TXA2, and leukotriene B4(LTB4) also increased at the same time even in cases where C5a changed only minimally, and may play a role in accumulating antitumor PMNs in the cavity.

[Microcarcinoma of the pancreas: report of a case]

A 53-year-old man complaining of vertigo initially consulted a nearby hospital. While undergoing a medical examination, which included abdominal ultrasonography and a CT scan, a dilatation of the pancreatic duct was found. The patient was then admitted to our hospital for a more thorough examination. Laboratory findings revealed an elevated elastase-1 level and a DM-pattern of 75 g-OGTT. ERP showed a localized constriction in the main pancreatic duct and diffuse dilatations of the distal main duct. A cytologic examination revealed no malignant cells in the pancreatic juice. Even so, though a carcinoma was not confirmed, a pancreaticoduodenectomy was performed, since a carcinoma of the pancreas head was suspected. A histological examination of the resected specimen uncovered a nonfunctioning islet cell carcinoma, 8 mm in diameter. This case was considered fortunate, in that an early stage pancreatic cancer, adjacent to the main duct, had been detected by imaging diagnoses.

[Clinical observations of hepatic artery infusion therapy combined with hepatic artery ligation in metastatic liver cancers]

Twenty-five patients with liver metastases from advanced gastrointestinal cancers were treated by hepatic arterial infusion chemotherapy by insertion of a catheter into the hepatic artery. All patients also underwent ligation of the hepatic artery. The anticancer agents used were adriamycin 10-30 mg, mitomycin C 10-20 mg and 5-fluorouracil 250-500 mg. The effect was assessed according to the criteria for clinical evaluation of chemotherapy for solid cancers by Koyama and Saito. The response rate for partial response was 24.0% among all 25 patients, including 25.0% (2/8) for stomach cancer and 28.6% (4/14) for colorectal cancer. The survival time with palliative resection of the primary lesion was prolonged significantly (p less than 0.05) in comparison with no resection. As for the side effects of hepatic arterial infusion chemotherapy, bone marrow suppression was most frequently found in 80.0% of patients, followed by gastrointestinal symptoms in 68.0%. In addition, fever occurred in 20.0%, stomatitis in 20.0%, liver dysfunction in 16.0% and alopecia in 4.0%. However, the side effects were all controllable. As to hepatic artery ligation, there was no serious complication except for one case of liver abscess.

[Intraperitoneal cavity injection of OK-432 with fresh human serum in a case of carcinomatous peritonitis--determination on the complement-derived chemotactic factor]

Large numbers of neutrophils appear in the peritoneal cavity within a few hours after administration of OK-432 into the peritoneal cavity, and play an important role in the destruction of cancer cells. As OK-432 can activate complement in vitro, it is possible that a chemotactic factor such as C5a is generated and attracts neutrophils into the cavity. We injected OK-432 with fresh human serum preincubated at 37 degrees C for 60 min in order to generate large amounts of complement-derived chemotactic factor. Neutrophils increased in number within a few hours after the injection of OK-432 with preincubated human serum into the peritoneal cavity of a recurrent gastric cancer patient with carcinomatous ascites, and persisted much longer compared with treatment using OK-432 alone. Cancer cells rapidly decreased in number and ascites disappeared two weeks after the treatment with OK-432 and preincubated human serum. It was found that C5a levels measured by RIA initially increased a few hours before neutrophils appeared, and then decreased gradually, after injection of either OK-432 with preincubated human serum or with OK-432 alone. Although complement-derived chemotactic factor might be responsible for attracting neutrophils into the peritoneal cavity, the role of other chemotactic factors should also be investigated.

Influence of human serum on bactericidal activity of ceftizoxime sodium

The influence of normal human serum on bactericidal activity of ceftizoxime sodium (CZX) was studied in vitro against Escherichia coli and Staphylococcus aureus. Subminimal inhibitory concentrations of CZX inhibited the growth of bacteria. Normal human serum as a source of complement and low doses of CZX, such as 1/20 or 1/10 the minimal inhibitory concentration, had a strong synergic action on the gram-negative bacteria E. coli, but not on the gram-positive bacteria S. aureus. However, the combination of CZX and fresh human serum had a stronger inhibitory effect on the growth of S. aureus than CZX alone. It is concluded that subminimal inhibitory concentrations of CZX inhibited the growth of bacteria in vitro in the presence of human serum, indicating that smaller dosages of CZX may act to eliminate the invading bacteria in vivo together with serum complement.