Myelodysplastic syndromes (MDS) are common malignant disorders with a poor prognosis. MDS are a group of highly heterogeneous disorders but show certain universal findings including a high incidence in the elderly population, cytopenia, dysplastic myeloid cells, and frequent transformation to acute myeloid leukemia. Until recently, the vast majority of MDS patients were treated with supportive therapy alone, such as transfusions. Allogeneic stem cell transplantation (SCT) has the potential for cure, although due to the age and comorbidity of MDS patients, the role of allogeneic SCT in MDS has been limited. Recently, research in MDS has shown substantial advances that have deepened our understanding of MDS pathophysiology and changed our approach to MDS patients. This review touches on some recent developments in the diagnosis and pathophysiology of MDS.

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Cyclo-oxygenase (COX)-2 is not usually detectable in normal tissues but is induced in inflammation and carcinogenesis. The level of COX-2 is elevated in cancer tissues of the colon, bladder, and skin. In the esophagus, squamous cell carcinoma and adenocarcinoma are known to express COX-2. The purpose of this study was to clarify the association of COX-2 expression with clinicopathological factors of squamous cell carcinoma. The immunohistochemical expression of COX-2 was examined in 48 surgical specimens of esophageal squamous cell carcinoma. Although COX-2 over-expression was more frequently observed in tumors invading the submucosa (T1b, 76.4%), muscularis propria (T2, 57.1%), adventitia, or adjacent organs (T3∼4, 83.3%), even 33.3% of mucosal cancers, such as T1a, showed COX-2 over-expression. COX-2 over-expression was present in 82.3% of lymph node-negative patients but in only 54.8% of lymph node positive patients. There was no difference in COX-2 over-expression between the earlier stages (0 and I, 60%) and more advanced stages (II∼IV, 69.6%). COX-2 over-expression did not correlate with survival during 3 years of follow-up. These findings suggest that COX-2 is associated with the phenotype of the esophageal squamous cell carcinoma cells, including superficial cancer cells, and may be related to tumor growth in esophageal squamous cell carcinoma.

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Background: Bronchopleural fistula is a poentioally fatal complication of pulmonary resections, especially pneumonectomy.
Methods: Univariate and multivariate analyses of the development of bronchopleural fistula were performed in 12 patients with bronchopleural fistula and 102 patients without bronchopleural fistula who had undergone pneumonectomy from January 1983 through December 2005.
Results: Bronchopleural fistula developed after pneumonecotomy in 12 patients (8.5%). Seven (58.7%) of the 12 patients died of bronchopleural fistula. Univariate analysis showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease significantly contributed to the development of postpneumonectomy bronchopleural fistula (p=0.0002, p=0.0043, and p=0.0387, respectively). Multivariate analysis also showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease were significant risk factors for postpneumonectomy bronchopleural fistula.
Conclusions: Bronchopleural fistula is strongly associated with preoperative infection, right pneumonectomy, and pathological N2, 3 disease. Bronchial stump coverage with pedicled tissue flaps and preservation of the bronchial arteries during mediastinal lymphnode dissection are recommended to maintain the blood supply to the bronchial stump in patients at risk.

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Background: Improvements in reconstructive mammoplasty methods have made it possible to resect more of the mammary gland while achieving good esthetic results in breast-conserving surgery. We report the esthetic results of extended wide resection of the breast with reconstruction procedures.
Methods: Breast-conserving surgery was performed using a video-assisted breast surgery (VABS) technique. Breast reconstruction was simultaneously performed using the following three methods: mobilization of the remnant mammary gland, transplantation of the lateral tissue flap, and filling with an absorbent synthetic fiber mesh or cotton. The cosmetic results were evaluated with an original five-item-by-four-step scoring system: ABNSW-assessing asymmetry, breast shape, nipple shape, skin condition, and wound scar.
Results: From December 2001 through March 2006, we performed endoscopic VABS in 130 patients with breast diseases. The candidates were 29 patients with breast cancer who required resection of more than 33% of the mammary gland because of ductal carcinoma in situ (1 patient), multiple cancers (6 patients), widely extended lesions (20 patients), and lesions after preoperative systemic therapy (2 patients). Twenty-one patients underwent resection of 33% to 50% of the breast, and 8 underwent resection of more than 50% of the breast. All surgical margins were negative on examination of permanent histological preparations. The original shape of the breast was preserved. There was no local recurrence after follow-up times of 33 months (maximum) and 19 months (average).
Conclusions: The newly devised reconstruction methods with VABS can markedly increase the mammary gland resection volume while achieving a good esthetic outcome, ensuring a precise disease-free surgical margin, and expanding the indications for breast-conserving therapy.

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We report two cases of subacute combined degeneration. Both patients had undergone total gastrectomy. The chief complaints were numbness in both upper extremities in case 1 and numbness in both the upper and lower extremities and gait disturbance in case 2. The pain, temperature, and vibration senses of both patients were decreased. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 level in both cases. In both cases T2-weighted magnetic resonance images showed an area of hyperintensity in the dorsal columns of the cervical spinal cord. The patients were treated with vitamin B12. The abnormal signals had disappeared on follow-up magnetic resonance examination 1 year later in case 1 and 3 months later in case 2. These patients showed neurological improvement, but the numbness in the upper extremities persisted even after the area of abnormal signal intensity had disappeared in case 1.

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Background: Congenital ectopic nails are rare and are characterized by the presence of nail-like tissue mainly at the tip of a finger or toe.
Objective: Although the accompanying bone deformity might undergo remodeling after removal of the ectopic nail, it remains unknown whether complete bone remodeling can be eventually achieved, and whether such remodeling is necessary to improve the final cosmetic appearance of the concerned fingertip.
Methods and Results: Follow-up with periodic radiographic examination for 1 year after surgery in a child with congenital ectopic nail revealed no bone remodeling, despite the satisfactory cosmetic result.
Conclusion: We conclude that residual bone deformity does not affect the final appearance.

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We report a case of perforation of the esophagus associated with mediastinitis and pneumomediastinum during endoscopic treatment. The patient was successfully treated by means of nonsurgical computed tomography-guided mediastinal drainage. Esophagoscopy demonstrated a scar on the 14^th day at the perforation site. This nonsurgical treatment with computed tomography-guided mediastinal drainage is proposed as a less invasive treatment for iatrogenic perforation of the esophagus.

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We report on a 41-year-old man with hematemesis and severe epigastric pain. Three hours after the onset of symptoms, we carefully performed upper gastrointestinal endoscopy for suspected upper gastrointestinal perforation. Endoscopy revealed a 2.5-cm-long longitudinal laceration of the lower esophagus without active gastric or duodenal ulcers. The laceration could be partially closed with endoscopic clipping. Computed tomography of the chest revealed a small amount of extraluminal air in the mediastinum. Neither pleural effusion nor pneumothorax was detected. We treated the patient conservatively on the basis of the following factors: a stable general condition without sepsis, limitation of the esophageal disruption to the mediastinum, and early diagnosis. The treatment course was uneventful, and the patient was discharged from the hospital after we had confirmed with endoscopy that the esophageal ulcer was completely healed. Although Boerhaave syndrome is generally considered to have poor prognosis, conservative therapy may be effective in select cases with early detection of the perforation.

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A 54-year-old man was admitted to our hospital with the symptoms of palpitation, dyspnea, and tarry stool. Upper gastroduodenal endoscopy revealed submucosal lesions with vascular ectasia in the second part of the duodenum. Dynamic computed tomography (CT) detected a hypervascular lesion in the pancreatic head and the duodenum. Selective angiography showed proliferation of a vascular network and early filling of the portal vein at the early arterial phase. With a diagnosis of pancreatic arteriovenous malformation (AVM), we performed pylorus-preserving pancreaticoduodenectomy. At laparotomy, localized and meandering vessels were seen on the surface of the head of the pancreas. Histological examination showed dilated tortuous vessels accompanied by severed elastic fibers in the vessel media and blood clot formation. The incidence of pancreatic AVM remains extremely low, and recurrent gastrointestinal bleeding is a frequent complication. To prevent recurrent bleeding and progressive portal hypertension, surgery may be the definitive management of symptomatic AVM.

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We retrospectively analyzed the clinical significance of placental position in patients with placental abruption by comparing cases in which the placenta was implanted on the anterior wall of the uterus (n=17) and those in which the placenta was on the posterior wall (n=12). There were no significant differences in clinical features of patients or pregnancy outcomes between the two groups. In this study, all patients with an anterior-wall placenta received a diagnosis of placental abruption prenatally, whereas only 8 patients (67%, p=0.01) with posterior-wall placenta received a diagnosis of placental abruption prenatally. Serious consideration should be given to the diagnosis of placental abruption in patients with a posterior-wall placenta.

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