This study aimed to evaluate the frequency and extent of chemotherapy-induced nausea and vomiting (CINV) in patients with colorectal cancer (CRC) who underwent chemotherapy, using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT), and establish an antiemetic protocol for the management of CINV, independent of the treating oncologist. We conducted a prospective observational study from October 2017 to June 2018 at the Higashihiroshima Medical Center. Patients who had undergone moderate CINV risk chemotherapy for CRC were eligible. The incidence of CINV was evaluated using the MAT, and medical prophylaxis was gradually provided following the antiemetic protocol. We enrolled 30 patients, and 27 of 30 patients (90%) were assessed more than once using the MAT. Among these 27 patients, the incidence of acute nausea was 30% and delayed nausea was 26% as evaluated using the MAT based on recommended pharmacological prophylaxis guidelines. Between the start and end of the survey, there was no significant difference in the numeric rating scale (NRS) score for acute nausea, but there was a significant reduction in the NRS score for delayed nausea. The clinical significance of the antiemetic protocol as assessed using the MAT in reducing CINV was demonstrated. The clinical use of the protocol may help in the realization that selective pharmacological prophylaxis for patients with CINV is possible, independent of the treating oncologist.

Previous studies have demonstrated that arterial stiffness is independently associated with the severity of pulmonary emphysema observed on computed tomography (CT) in patients with chronic obstructive pulmonary disease (COPD). An inverse correlation exists between emphysema severity on CT image and lung diffusing capacity; however, the relationship between lung diffusing capacity and arterial stiffness in patients with COPD remains unclear. We retrospectively analyzed the data of 30 patients with COPD. Percent predicted diffusing capacity of the lung for carbon monoxide divided by alveolar volume (%DLco/VA) was used as an index of lung diffusing capacity. We used the Goddard score as an index of the severity of pulmonary emphysema on CT image and cardio-ankle vascular index (CAVI) as an index of arterial stiffness. CAVI was inversely correlated with %DLco/VA (r = −0.539, p = 0.002) but not correlated with Goddard score (rs = 0.236, p = 0.209). None of the other respiratory parameters investigated, including forced expiratory volume in the first second (FEV₁), FEV₁/forced vital capacity ratio, and percent predicted FEV₁, were correlated with CAVI. In multiple regression analysis, systolic blood pressure (β = 0.404, p = 0.006), %DLco/VA (β = −0.379, p = 0.012), and modified Borg scale score for dyspnea (β = 0.304, p = 0.033) were significant predictors of CAVI. Lung diffusing capacity is a significant independent predictor of arterial stiffness in patients with COPD. The evaluation of %DLco/VA in patients with COPD might be useful for predicting high CAVI and the development of cardiovascular disease in the future.

Primary retroperitoneal cystic lesions (PRCLs) are extremely rare, and their histogenesis and clinical evolution remain unclear. Here, we report the case of a 38-years-old primigravida who was referred to our hospital for the delivery. Routine ultrasonographic examination at 36 weeks of gestation revealed the presence of a cystic mass close to the right side of the uterus. One month after the childbirth, we performed the surgery. The cystic mass was present on the right side of the retroperitoneal cavity. We successfully extracted the cyst without rupture. The cyst was 12 × 6 × 3 cm, unilocular, exhibited a thin wall, and contained mucinous liquid. Histological examination revealed that the lining of the cyst comprised two types of adjacent cells. The flat low cuboidal cells were positive for calretinin, cytokeratin (CK) 5/6, CK7, cancer antigen 125 (CA125), and D2-40, all of which are mesothelial markers. The tall columnar cells were also positive for the mesothelial marker CK7. However, the flat low cuboidal cells were negative for mucinous cell makers, while tall columnar cells were positive for these markers. The tall columnar cells contained mucin but were not positive for gastrointestinal epithelial-specific secreted mucin makers. This finding directly supports our hypothesis that the retroperitoneal cysts emerged from the mesothelium.

We report a rare case of incidentally found metastatic adenocarcinoma in the abdominal para-aortic and inferior mesenteric root lymph nodes originating from the prostate, at the time of surgery in a patient with sigmoid colon cancer. A man in his mid-seventies was scheduled to undergo laparoscopic-assisted sigmoidectomy and regional lymph node dissection. At the beginning of laparoscopic surgery, a caterpillar-like swelling of abdominal para-aortic lymph nodes was found; the diagnosis using frozen sections was a metastatic adenocarcinoma showing cribriform and solid growth patterns different from typical colorectal cancer. The surgical procedure was changed to an abdominal sigmoidectomy with widely extended lymph node dissection, including inferior mesenteric root lymph nodes and sampling of abdominal para-aortic lymph nodes. The resected sigmoid colon cancer was a papillary/tubular adenocarcinoma invading the muscularis with no lymph node metastasis (pT2N0M0/pStage IIA). Additionally, the presence of a metastatic adenocarcinoma showing cribriform and solid growth patterns different from the primary sigmoid colon cancer was confirmed in the abdominal para-aortic and inferior mesenteric root lymph nodes. The metastatic adenocarcinoma cells were positive for prostate-specific antigen (PSA) and negative for CDX2, indicating that the tumor was from the prostate. A total of ten prostatic core needle biopsy specimens also contained a usual (acinar) adenocarcinoma, with a Gleason score of 4 + 5 = 9. Androgen blockade was performed; the serum PSA level was reduced to 0.06 nanograms per microliter in the subsequent five months. Regardless of radiologic images, examination of serum PSA level is recommended before surgery in male surgical colorectal cancer patients more than 60 years old.