It is challenging to demonstrate the capsule of Streptococcus　pneumoniae　(S.　pneumoniae) under immunoelectron microscopy because of the thick mucopeptide cell wall hampering proper fixation. A novel rapid freeze fixation method was established to observe the capsule of S. pneumoniae. A strain of serotype 3 of S. pneumoniae isolate was analyzed after rapid freezing. An ethanol freezing-substitution fixing method was applied and immunohistochemical staining with osmium tetroxide was tested. The capsule was confirmed using the serotype 3 specific polyclonal antibodies labeled with colloidal gold particles. To the best of our knowledge, this is the first report of S. pneumoniae capsule by immunoelectron microscope.

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【Objective】The purposes of this study were to classify the lesions of dialysis-associated spondylosis and evaluate the results of surgical treatment. 【Subjects and methods】The subjects were 87 patients (43 men and 44 women) who underwent surgery. These patients were studied in terms of lesion classification, surgical method, duration of dialysis, duration of surgery, intraoperative blood loss, and postoperative complications. 【Results】Among patients with cervical spine involvement, 13 had destructive spondyloarthropathy (DSA), 29 had amyloid deposition, and 8 had a dens axis lesion. Among patients with lumbar spine involvement, 20 had DSA, and 17 had amyloid deposition. With regard to 6 patients with a dens axis lesion involving atlantoaxial subluxation, each had posterior fusion (PF) of the occiput to the upper cervical spine. With regard to the patients with lumbar DSA, 10 patients had posterolateral fusion (PLF), 8 patients had posterior lumbar interbody fusion (PLIF) and 2 patients had laminectomy. The duration of dialysis in cases of a dens axis lesion varied between 25 and 35 years, with the mean duration being 28.9 years. 【Conclusions】All patients who underwent surgery for dens axis lesions were long-term dialysis patients who had been on dialysis for 25 years. Lumbar spine DSA was treated with PLIF in patients with lateral slipping and marked instability, with laminectomy in patients with a narrowed intervertebral disk space and no instability.

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The aim of this study was to clarify a correlation between acute inflammatory response to surgery and different laparotomy lengths in patients who underwent colorectal cancer resection via a single minimal laparotomy. Between April 2005 and May 2008, 131 consecutive patients (59 women, 72 men), who were scheduled to undergo elective surgery for resection of primary colorectal cancer using a single minimal skin incision, were enrolled in this study to investigate the correlation between postoperative acute inflammatory responses (as measured by serum C-reactive protein (CRP) levels and white blood cell count (WBC)) and different laparotomy lengths. According to the length of laparotomy, the patients were grouped into 3 categories, "small-incision" ( ≤7 cm), "medium-incision" (>7 and ≤14 cm), and "large-incision" (>14 cm) for comparison. Statistical analyses were conducted using the Kruskal-Wallis test with multiple comparison post-hoc and chi-square tests. The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P=0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( ≤7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection.

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Subconjunctival fat herniation is rarely described in the literature, but it is common in clinical practice. It represents prolapse of the intraconal fat to the subconjunctiva, mainly from aging. It usually occurs in the superotemporal quadrant of the globe, and rarely causes symptoms. Microscopically, multinucleated giant cells that frequently have a floret-like appearance (floretlike cells), and also bizarre adipocytes with nuclear vacuoles (Lochkern cells) are seen. We present a case of a 68-year-old Japanese man with subconjunctival fat herniation that showed floret-like cells and Lochkern cells. The differential diagnosis included lipomatous tumors of the orbit such as pleomorphic lipoma, liposarcoma, as these resemble subconjunctival fat herniation macroscopically. It is important to make a histopathological diagnosis for fat herniation to avoid overlooking malignant tumors and over-treating benign lesions.

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An 89-year-old female was admitted to our hospital because of fever and abdominal pain. The patient had used an antihypertensive agent, but had not used either antibiotics, steroids, or potent antacids. An abdominal CT scan revealed free air and ascites. An emergency operation was performed for acute peritonitis caused by a gastrointestinal perforation. A perforated ulcer was observed at the posterior wall of the gastric body. A distal gastrectomy with intraperitoneal drainage and a Billroth II reconstruction was performed. A histological examination demonstrated a perforated ulcer surrounded by Candida infection. The patient developed an abscess in the abdominal cavity, but was discharged on the 52nd postoperative day. Although gastrointestinal Candida infection is commonly seen in immunocompromised host with diabetics or malignant diseases, habitual use of strong antacids can also cause severe Candida infection of the stomach in healthy persons. In this case, it was thus concluded that there may have been a decrease in immunity in this patient because of her advanced age 89 years old and malnutrition.

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