A large amount of radioactive materials was scattered in the atmosphere by the accident of the Fukushima Nuclear Power Plant and brings many nations radiation exposure and gives uneasiness. In this paper, the actual situation of a natural radiation and the artificial radiation and low dose radiation of radioactive materials are reviewed and biological effects on human, especially stochastic effects including induction of cancer are discussed. Moreover, recommendations and guidance on all aspects of protection against ionizing radiation are provided.

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Purpose:We evaluated gastrojejunal bypass utility in treating advanced unresectable gastric cancer. Methods:Pre– and postoperative oral uptake and nutritional status were studied in 23 subjects—15 men and 8 women with a mean age of 72 years—seen for advanced unresectable gastric cancer, having pyloric stenosis, and treated by gastrojejunal bypass over a 9–year period. Surgery was done for 20 cases of primary gastric cancer and 3 of remnant gastric cancer. Results:Oral intake became possible postoperatively in 22 subjects (96%). The one unable to be fed orally had had a cerebral infarction. Of the 23, 19 (83%) were discharged. Postoperative survival was 232 days. Discussion: The fact that the majority of subjects were able to eat orally again demonstrates the utility of gastrojejunal bypass. More cases are needed and indications must be studied further, however.

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Purpose: We identified appropriate colon cancer dissection area for muscularis propria (MP) invasion.
Subjects and methods: Clinical outcomes were studied retrospectively in 84 MP cancer subjects based on tumor site. These were clinicopathologically compared to 180 subjects with subserosa invasion (SS cancer).
Results: No difference was seen in left or right–side sites for curative surgery frequency, lymph node metastasis, or main or intermediate lymph node metastasis. Lymph node metastases were fewer at 23.8% in MP cancer with curative surgery than in SS cancer at 33.5% (p=0.08). No significant difference was seen in main or intermediate lymph node metastasis rates, recurrence in those with main or intermediate lymph node metastasis, or prognosis between MP and SS cancer.
Conclusions: Main and intermediate lymph node dissection is recommended for MP cancer just as for SS cancer.

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A 40–year–old man with no marked medical history seen for pharyngeal and submandibular pain 1 month after tooth extraction was diagnosed with peritonsillar abscess, maxillary sinusitis, and cervical cellulitis. After admission, he suffered dyspnea that night, requiring emergency tracheotomy. With respiratory problems progressing to near—acute respiratory distress syndrome, he required emergency bilateral thoracic drains inserted for a P/F ratio below 100 and for difficulty in maintaining oxygenation. A large volume of blackish necrotized fluid was drained. The retropharyngeal space, posterior mediastinum, and bilateral mandibular region were drained and irrigated continuously. Despite 3 months of hospitalization, including swallowing training, he has continued to maintain a favorable course in the 15 months since discharge. Cervical preparation of retropharyngeal and posterior mediastinal drainage pathways without thoracotomy facilitated stepwise abscess removal and disease remission.

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A 57–year–old man seen for an abnormal right lung shadow was found in computed tomography (CT) to have a 30 mm lesion with a central low–density area in the middle right lobe. Although pathological examination in transbronchial biopsy showed no malignant findings, radiological findings strongly suggested lung cancer, necessitating right middle lobectomy. The postoperative course was uneventful. Histopathologically, the lesion was pulmonary actinomyces. Pulmonary actinomyces is difficult to distinguish from lung cancer clinically or in imaging. Surgical resection may thus be useful diagnostically and therapeutically.

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A 61–year–old man underwent preoperative chemotherapy, followed by subtotal esophagectomy with gastric tube reconstruction for esophageal cancer. The day after the operation, he suddenly showed septic symptons. Upper gastrointestinal endoscopy revealed necrosis of the gastric tube mucosa, and emergency surgery was performed. On post operative day (POD) 3, the patient went into acute renal failure, and on the same day, erythema and subcutaneous emphysema appeared in his bilateral thoracic skin, with development of necrotic change. On POD5, Aeromonas hydrophila was detected in the ascites taken during the reoperation. Although necrotic tissue was resected during reoperation and antibiotic treatment with an A.hydrophila sensitive drug was performed, the patient's condition deteriorated. On POD 8, the skin lesion progressed to necrotic fasciitis and he died on POD16. A.hydrophila infection after gastrointestinal surgery is very rare. When the patient's condition significantly deteriorates within a short time after gastrointestinal surgery, it is important to consider the possibility of A.hydrophila sepsis or infection.

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Postoperative reflux esophagitis and dumping syndrome are well known to follow total gastrectomy. We report a case of severe reflux esophagitis developing in a 73–year–old man after total gastrectomy with Billroth–II (B–II) reconstruction. He was treated by partially resecting the afferent loop and converting to Roux–Y reconstruction. Remnant total gastrectomy with B–II reconstruction was done elsewhere in September 2005 for residual stomach cancer after gastrectomy with B–I reconstruction for a gastric ulcer. Severe reflux esophagitis developing immediately postoperatively did not improve in conservative treatment. The man was referred in November 2008. Barium examination showed severe esophageal reflux due to circulation between efferent and afferent loops via the Braun anastomosis. Reconstruction converted to Roux–Y reconstruction by partially resecting the afferent loop markedly relieved postoperative esophagitis.

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We report a case of giant duodenal ulcer perforation with septic shock and hyperkalemia in which intensive treatment saved the subject. A 68–year–old man treated regularly elsewhere for lumbar spinal canal stenosis was seen in an emergency for lumbar backache lasting 10 days. Abdominal computed tomography (CT) showed free air and ascites. Decreasing blood pressure immediately after CT prompted dopamine administration. Following abdominal swelling and peritoneal irritation over the entire abdomen, a blood test confirming hyperkalemia necessitated calcium gluconate injection and immediate surgery. Laparotomy showed a giant two–thirds circumferential 5×3.5 cm duodenal ulcer perforation in the anterior duodenal bulb wall, containing 2,300 ml of purulent ascites. Simple duodenal closure, omentopexy, jejunostomy, and abdominal cavity drainage were done because blood pressure could be maintained during surgery with 0.3 μg/kg/min of norepinephrine. Continuous postoperative hemodiafiltration was done under mechanical ventilation in the ICU, gradually improving the man's general condition.

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The development of metastasis to the duodenum and of bladder cancer to the intestine is very rare. We report such a case.
A 75–year–old man undergoing total cystectomy 4 years earlier for bladder cancer was admitted for chemotherapy for paraaortic lymph node recurrence.
Upper gastrointestinal endoscopy showed a duodenal bulb ulcer scar and descending duodenum stenosis. The pathological duodenal specimen diagnosis was unresectable adenocarcinoma, i.e., a clinical diagnosis of duodenal carcinoma. Gastrojejunostomy was done to unable oral parenteral nutrition. A hard mass in the descending duodenum and enlarged gastric lymph nodes suggested metastatic transitional cell carcinoma confirmed by immunopathological examination.
The final diagnosis was transitional cell carcinoma of the bladder with duodenum and paraaortic lymph node metastasis.

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A 41–year–old man presented with general fatigue, tarry stool and epigastralgia. Hematological examination data showed an anemia (Hb 9.3g/dl). No abnormalities were found on upper gastrointestinal endoscopy and colonoscopy. Therefore patient was received a video capsule endoscopy. A stenosis with reddish and edematous mucosal changes was recognized at the upper jejunum. Furthermore, double–balloon enteroscopy was added to this patient. Pathological studies of the biopsy specimens diagnosed a primary small intestinal adenocarcinoma. Computed tomography showed the regional lymph node metastasis without distant metastasis. The patient was received a radical operation. Primary small intestinal adenocarcinoma is a rare malignancy ; most cases cannot be detected on routine gastrointestinal endoscopy due to their location. Therefore, it is often that diagnosis is late. Our experience suggests that double–balloon enteroscopy and video capsule endoscopy are useful for diagnosing small intestinal adenocarcinoma.

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A 45–year–old woman was admitted to a local hospital because of abdominal pain, but the symptom did not resolve. Therefore, she was admitted to our hospital the next day. On admission, she had abdominal pain with muscular defense and abdominal distension. Since plain abdominal CT showed ascites and the “whirl sign”, emergency surgery was performed. At laparotomy, 300 ml of blood–tinged ascitic fluid was found. Since the right hemicolon, including a mobile cecum, was found to be twisted 360 degrees counterclockwise around the mesentery and necrotized, right hemicolectomy was performed.

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A 20–year–old woman presented at the emergency department with acute right lower abdominal pain. Physical and laboratory examinations indicated acute appendicitis with periappendiceal infiltrate, and the patient underwent appendectomy. However, histological examination of the appendectomy specimen revealed carcinoid tumor with acute inflammation. Therefore, the patient underwent laparoscopic radical ileocecal resection with lymph node dissection two months after the appendectomy. Pathological examination of the resected specimen did not show any tumor in the ileocecal region, but massive metastases in 2 of 35 analyzed lymph nodes were observed.
This case evidences that carcinoid tumor of the appendix can easily be missed without histological examination. Routine careful pathological examination of appendectomy specimens is warranted because further surgery and chemotherapy may be necessary.

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We report extremely rare cecal carcinoma with reverse intestinal malrotation. A 73–year–old man seen for right abdominal pain and weight loss was found in gastric fibroscopy to have a gastric pus accumulation. He was diagnosed with cecal carcinoma, panting stomach, and reverse intestinal malrotation. Abdominal computed tomography (CT) showed that the jejunum passed the ventral superior mesenteric artery. Laparotomy showed the small intestine located ventral to the superior mesenteric artery and the transverse colon dorsal to the superior mesenteric artery—signs of reverse rotation. The man underwent distal gastrectomy and right hemicolectomy. Reversed intestinal rotation is very rarely in adults

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A 72–year–old woman seen for anal bleeding starting one month earlier was found in colonoscopy to have an 18 mm black pedunculated rectal tumor 4 cm orally from the anal verge. The biopsy diagnosis was malignant melanoma. We radically resected the rectum. The pathological finding was malignant melanoma, pSM , pN2, ly1, v1, pPM0, pDM0, pRM0. Postoperative adjunctive chemotherapy involved dacarbazine (DTIC), nimustine (ACNU), and vincristine (VCR). Abdominal CT found no metastasis three months postoperatively, but liver metastasis was seen six months later, necessitating DAC Tam therapy with DTIC, ACNU, cisplatin (CDDP) and tamoxifen (TAM). The woman died one year and one month after the lest operation. Anorectal melanomas are highly malignant, with even an early tumor with SM invasion posing a poor prognosis, making the selection of operative procedures very difficult.

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A 46–year–old woman seen for lower abdominal pain was suspected of having an ovarian tumor. Magnetic resonance imaging (MRI) suggested mesenteric origin confirmed by abdominal computed tomography (CT). Based on a diagnosis of mesenchymal tumor arising from the sigmoid colon or mesentery, she underwent minilaparotomy, which found an oval tumor originating in the sigmoid colon wall. The tumor, removed by sigmoid colon wedge resection, consisted of palisade–like spindle cells. Immunohistochemical staining showed tumor cells to be negative for CD117, CD34, and S100β and positive for h–caldesmon. The final diagnosis was extra–intestinal sigmoid colon leiomyoma. Leiomyoma is difficult to diagnose preoperatively even with tumor vessels identified by CT or MRI.

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A 56–year–old man with a left cervical tumor had been treated for chronic hepatitis B and hepatocellular carcinoma in transcatheter arterial embolization elsewhere 6 months earlier. Excision biopsy showed a hard cervical tumor diagnosed as hepatocellular carcinoma metastasis necessitating radical dissection under general anesthesia. Liver tumors were then treated with radiofrequency ablation. A year after dissection, he was seen for a right–neck tumor. Computed tomography (CT) and positron emission tomography (PET) showed recurrent hepatocellular carcinoma and right subclavicular, mediastinal, and parasternum metastasis. We conducted total lymph node dissection and transcatheter arterial chemoembolization. Sorafenib was prescribed but the tumor grew and the man died of liver failure. Remote metastasis is rarely reported. Careful surgical selection is important in treating aggravated hepatocellular carcinoma with cervical lymph node and distant metastasis.

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A 50–years–old woman was admitted to another hospital with exacerbating epigastralgia and abdominal bloating. In April 2008, a liver cyst was discovered on abdominal CT. In April 2010, she was admitted to our hospital for worsening abdominal symptoms. The liver cyst had enlarged to 10 cm in diameter and a gallstone was identified with abdominal CT and ultrasonography. The patient was treated with one–stage liver cyst fenestration and cholecystectomy via single–incision laparoscopic surgery. The operation time was 147 minutes (75 minutes for liver fenestration and 72 minutes for cholecystectomy). Blood loss was minimal. The patient was discharged on the third day after the operation.

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A 64–year–old man with chronic hepatitis C seen for a hepatic tumor was found in ultrasonography (US) to have two liver tumors—one at segments 5 to 8 and one at segment 7. Both were shown by computed tomography (CT) to have enhanced delayed washout. Anterior segmentectomy and partial S7 resection were done. The S5 to 8 tumor was diagnosed histologically as cholangiocellular carcinoma (CCC) and the S7 tumor as hepatocellular carcinoma (HCC). Simultaneous HCC and CCC at different hepatic sites—termed double cancer—is very rare. We report this case and bibliographical comments.

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A 66–year–old woman seen for epigastralgia from the previous month was found in upper gastrointestinal (GI) endoscopy to have large gastric residue. Strictural biopsies showed moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed pyloric antrum thickening and swollen lymph nodes around the stomach. The preoperative diagnosis was lactic dehydrogenase (LD) gastric cancer, circ, type 3, T4a (SE) N1, stage IIIB.
Intraoperative findings showed the gall bladder and duodenal bulb involving the omentum with gall bladder cancer. The Gall bladder bed was resected and distal gastrectomy done with bile duct resection. The lower end of the common bile duct was ligated and the bile duct and jejunum anastomosed with Roux–en–Y reconstruction and Billroth II remnant stomach treatment. The redness of the resected antrum mucosa specimen and bile duct mucosa was normal. The final diagnosis was gastric gall bladder cancer invading the bile duct and stomach.
Gall bladder cancer had infiltrating the pylorus. Gall bladder atrophy necessitates considering the possibility of gall bladder cancer.

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We report a case initially diagnosed as infected pancreatic pseudocyst after acute pancreatitis and treated by repeated endoscopic drainage, in which the final diagnosis was mucinous cystadenocarcinoma.
A 60–year–old woman was admitted to our hospital's gastroenterology department after developing acute pancreatitis and what seemed to be recurrent infected pseudocyst of the pancreatic tail. This was treated by endoscopic transpapillary drainage. However, because the cyst enlarged on imaging and serum carbohydrate antigen 19–9 level increased, we decided to treat the case surgically. Postoperative pathological examination revealed mucinous cystadenocarcinoma with direct invasion of the spleen and transverse colon.

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We report a case of small–intestine metastasis from renal pelvic carcinoma. A 63–year–old man who had had left renal pelvic cancer had undergone nephroureterectomy and adjuvant chemotherapy. Four years later, renal pelvic cancer was found to have metastasized to the left adrenal gland and paraaortic lymph node. The disease remained stable and 1 year of chemotherapy was successful. Five years postoperatively, he was admitted with bowel obstruction due to small–intestine nerrowing. Biopsy showed poorly differentiated adenocarcinoma diagnosed as primary small–intestine carcinoma and necessitating radical resection. Histolopathologically, resected small–intestine specimens showed the same renal pelvic cancer as before, l.e., poorly differentiated carcinoma, confirmed by Immunostaining. The final diagnosis was thus small–intestine metastasis from renal pelvic carcinoma.

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We report a case of hematuria due to glycerin enema. Immediately following a 50 ml glycerin enema administered for constipation in November 2010, the subject suffered strong anal pain. This was followed an hour later by macroscopic wine–colored hematuria, scrotal enlargement, and redness, prompting the subjects hospital visit. Suspecting anaphylactic shock due to microscopic anal mucosa injury from the enema, we conducted steroid therapy. Macroscopic hematuria disappeared on day 2 and the subject was discharged on day 6. An anoperineal skin ulcer occurring on day 9 disappeared on day 45 with conservative treatment. Colonoscopy on day 79 showed an ulcer scar on the anal verge inlet. We review bibliographical considerations.

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Idiopathic mesenteric phlebosclerosis (IMP) is a rare ischemic disorder of the colon associated with phlebosclerosis of the mesenteric vein. We report on a particularly rare case of idiopathic mesenteric phlebosclerosis complicated by carcinoma. An 82–year–old Japanese male complained of weight loss. He was diagnosed as having carcinoma of the transverse colon and was admitted to our hospital for treatment. Colonoscopy showed that the colonic mucosa was dark blue–purple and edematous. An ulcerative lesion was observed at the transverse colon. Computed tomography showed marked thickening of the wall of the ascending and transverse colon with intramural and mesenteric vein calcification. Luminal narrowing was revealed at the hepatic flexure of the transverse colon. These preoperative examinations revealed a transverse colon carcinoma complicated with IMP. A right hemicolectomy was performed. Macroscopically, the tumor existed at the hepatic flexure of the transverse colon. The mucosa surrounding the tumor showed a slightly dark purple–colored and edematous surface. Histpathological examinations revealed collagen deposition around the vessels in the mucosa and marked fibrous mural thickening with calcification of the mesenteric veins and their branches. We diagnosed this as IMP accompanied by carcinoma. IMP is a rare disease that has been reported only in Asian countries, especially in Japan. It has been suggested that IMP exhibits race specificity. However, the etiology of IMP has not yet been fully elucidated. To our knowledge, only three cases of IMP accompanied by carcinoma have been reported, including this case. Further investigation of additional cases is required.

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A 37–year–old woman seen for a hard immobile 15 cm tumor of the lower abdomen was found in abdominal ultrasonography to have a lesion with heterogenous echogenicity and a clear border. Abdominal computed tomography (CT) showed a solid tumor with nearly homogeneous density diagnosed as originating in the abdominal wall. After undergoing wide local tumor resection with a 1 cm surgical margin, she had an abdominal–wall defect reconstructed using the fascia lata. The histopathological diagnosis was a desmoid tumor. No evidence of recurrence has been seen in the 4 years since surgery. Abdominal desmoid tumors are relatively rare, and we report this case and bibliographical comments.

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Umbilical metastasis from malignant tumors known as Sister Mary Joseph's nodule is relatively rare. We report such a case occurring 5.25 years after colectomy.
A 32–year–old man seen for an umbilical mass had undergone colectomy for transverse colon cancer 5 1/4 years ago. Biopsy results indicated metastatic carcinoma. Abdominal computed tomography (CT) showed umbilical and left pelvic tumors. Positron emission tomography (PET) CT showed 18–fluoro–2–deoxy–D–glucose (FDG) tumor accumulation, yielding a diagnosis of umbilical and left iliac lymph node metastasis or peritoneal dissemination from colon cancer. Both tumors were resected. Pathological findings resembled colon cancer, with proliferation of atypical cells and mucus formation. The final diagnosis was umbilical metastasis from colon cancer via a pathway of umbilical and left pelvic tumors from colon cancer.

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A 40–year–old woman seen for abdominal pain and distension had been treated for appendicitis and felt occasionally dysmenorrheal since her teens, but had not been diagnosed with endometriosis. Admitted on a diagnosis of small–bowel obstruction after computed tomography (CT), her intestinal obstruction did not improve when treated conservatively, necessitating surgery. Laparotomy showed solid terminal ileum adhesion considered the cause of the obstruction, so the small intestine was partially resected. The histopathological diagnosis was endometriosis. Intestinal endometriosis is difficult to diagnose preoperatively due to imaging limitations. Intestinal endometriosis should thus be considered in the differential diagnosis of women with intestinal obstruction.

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