Malnutrition commonly occurs in patients with cancer. This situation can be associated with increased morbidity and mortality. The etiology is not clearly understood but decreased energy intake and increased energy expenditure may be involved. We aimed to investigate the energy metabolic status including energy expenditure in patients with various cancers. The clinical features and energy metabolic status measured by indirect calorimetry of 74 patients with cancer (50 men and 24 women; mean age, 64.7 years) were obtained from the medical records. Hypermetabolism was more common and REE/kg (resting energy expenditure / kg body weight) seems to be more reliable in estimating the true energy expenditure than %REE (measured REE / predicted REE). The REE/kg and VO₂ /kg (oxygen consumption per minute / kg body weight) varied among cancer types, i.e., they were significantly higher in gastric cancer than in hepatocellular carcinoma. Moreover, REE/kg and VO₂/kg was significantly higher in cancer stage IV than in stage I, or stages I and II. Patients with or at risk for malnutrition should receive appropriate nutritional support, which has to be personalized according to tumor site, tumor stage, and the nutritional status of the patient. This nutritional support should improve not only the patients' quality of life but also their survival.

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Using ultrasonography, we measured the largest vertical dimension for pockets of amniotic fluid (largest vertical pocket) directly before elective cesarean delivery in 42 pregnant women and compared the results to actual amniotic fluid volume (AFV). In another 3 pregnant women of vaginal delivery suspected polyhydramnios, we performed amniocentesis and successively recorded the largest vertical pocket and actual AFV, and finally made a fitting curve and correlative equation. A high degree of correlation was found between the largest vertical pocket measured by ultrasound and the actual AFV. The equation is: Y=63.03-8.46X+0.71X²-0.01X³+0.00006X⁴. Using the equation obtained which relates largest vertical pocket to actual AFV; a 30mm largest vertical pocket corresponds to an actual volume of 200ml, an 80mm largest vertical pocket to 800ml, and a 120mm largest vertical pocket to 3,000ml. In conclusion, the largest vertical pocket is well reflected in the actual AFV.

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Background   Pancreatic islet cell transplantation (ICT) is one of the standard treatments for type I diabetes mellitus (T1DM), based on the Edmonton protocol of 2000.¹⁾ A previous report presented the expected annual incidence of ICT recipients in Nagasaki Prefecture in 2006.^2),3) This report presents variations in the background of T1DM patients followed in this department and evaluated the current annual incidence of possible ICT recipients. Methods This study reviewed 128 TIDM patients followed at Nagasaki University Hospital in 2011, examined the annual incidence of ICT recipients based on the Japanese Islet Transplant Registry criteria and the population of Nagasaki, and compared those results in 2011 with those in 2006. In addition, the annual numbers of cardiac death donors who were considered ICT donor candidates in Nagasaki over this period were examined. Results The proportion of candidates suitable to be recipients in Nagasaki changed from 4% (3/75) in 2006 to 7.8% (10/128) in 2011. The estimated incidence of suitable recipient candidates increased from 1.0 per year to 1.8 per year. On the other hand, though the estimated number of donor candidates was 2.6 per year, which was the mean for the 7 years between 2002 and 2009, only one candidate was reported in 2010 and no candidate was reported in 2011 in Nagasaki. Conclusion Although securing donors has become difficult due to a new law on organ transplantation, the demand for ICT has increased and may continue increase in the future. Therefore, it is important to confirm the criteria in brain dead donors to determine whether the pancreas should be directed to the pancreatic transplantation or pancreatic islet transplantation.

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Introduction: Although abdominal ventral hernias are common, there is still no consensus regarding the most appropriate technique to be used for surgical repair. We herein present our initial experiences of laparoscopic ventral herniorrhaphy to repair abdominal ventral hernias. Patients: From April 2007 to March 2009, four patients were assigned to recieve laparoscopic ventral hernia repair. The operative technique was demonstrated. Additionally clinical factors, including operative time, length of hospital stay, complications, and recurrence rates, were evaluated. Results: All of the patients were successfully treated laparoscopically without conversion to open laparotomy. The median operative time was 107.5 (range 75 - 130) minutes and the mean length of hospital stay was 13 (range 5 -19) days. There were no significant complications or hernia recurrences during a follow-up period of 36 months ( median, 28 - 42 ). Conclusion: Laparoscopic repair of abdominal ventral hernias may therefore be a feasible option with a great potential to both improve treatment outcomes and reduce surgical morbidity.

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Invasive thymoma often invades adjacent organs, such as the pleura, lungs, pericardium, and great vessels; the superior vena cava and brachiocephalic vein are particularly susceptible. A 31-year-old woman was admitted after chemotherapy for invasive thymoma involving the superior vena cava and left brachiocephalic vein. During the operation, regional cerebral oxygenation was measured using the INVOS^TM5100C monitor to avoid adverse effects due to long-time total clamping of the superior vena cava because left brachiocephalic vein could not be reconstructed due to total occlusion of the distal lumen. We could decide if the SVC was safely clamped with this INVOS^TM5100C monitor. Then complete resection of the tumors was successfully performed, and a single artificial graft was used for reconstruction of the superior vena cava. Postoperative clinical course was uneventful, and she was discharged on the 18th postoperative day.

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Rosai-Dorfman disease (RDD) is an uncommon, non-neoplastic benign lymphoproliferative disease characterized by prominent, painless cervical lymphadenopathy with fever and leukocytosis. RDD is histologically characterized by emperipolesis, where large histiocytes become infiltrated with lymphocytes and plasma cells. Intracranial RDD is extremely rare. Only 79 cases have been reported, including the present case. Intracranial RDD is associated with headaches, seizures, and numbness caused by increased intracranial pressure. A 67-year-old Japanese woman presented with dizziness and was diagnosed with a tumor in the cerebral falx. The preoperative radiological diagnosis was meningioma. She had no lymphadenopathy. The patient underwent a craniotomy and tumor resection. The tumor consisted of lymphoid tissue with scattered lymph follicles. The infiltrating histiocytes showed emperipolesis. The histiocytes were immunoreactive for S-100 protein and CD68 and negative for CD1a, leading to the diagnosis of intracranial RDD. The postoperative course was uneventful without further therapy. The dizziness had not re-appeared and MRI demonstrated no recurrence of tumors for 7 months. Intracranial RDD shows a male predominance and occurs later in life than nodal RDD. The clinical manifestations and prognosis are variable depending on the location of the tumor and treatment. Most intracranial RDD have a benign course, but long-term follow-up is important, because recurrence has been observed.

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We herein report a case of carotid artery pseudoaneurysm following intensive treatment for hypopharyngeal carcinoma. An 81-year-old male had undergone surgery and concurrent chemoradiotherapy to treat hypopharyngeal carcinoma (T4aN1M0). This treatment led to a complete response, but pseudoaneurysms were formed at the external carotid artery in a contaminated wound. One of the pseudoaneurysms was located close to the bifurcation and thus caused intractable hemorrhaging. We performed endovascular treatment to achieve hemostasis. One year after the embolization, surgical removal of the endovascular devices from the infected area was performed. Three years have passed since the removal, and the patient is still alive without any complications. Primary endovascular treatment of an infected pseudoaneurysm could be an effective option for the treatment of acute lethal hemorrhaging.

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