Periodontitis is one of the most common chronic infectious disorders associated with anaerobic subgingival microflora. Host immune responses and lifestyle determine the extent and severity of periodontitis. Recently, many epidemiological studies have revealed that periodontitis affects systemic diseases, such as aspiration pneumonia, diabetes mellitus, arteriosclerosis, and pregnancy complications. In this review, we address the relationships between periodontitis and systemic diseases.

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We examined the effect and importance of neoadjuvant chemoradiotherapy (NACRT) and radical resection for advanced pancreatic body cancer with no distant metastasis. Since 2011, concomitant oral administration of TS1 and 50-Gy preoperative irradiation by three-dimensional conformal radiotherapy have been performed for pancreatic cancer. The subjects were 11 patients with cIVa tumors. We followed the guidelines of the National Comprehensive Cancer Network (NCCN). The 11 subjects included 2 patients with resectable cancer, 6 patients with borderline resectable cancer, and 3 patients with unresectable cancer. After NACRT, 1 subject with resectable cancer underwent resection, and the other patient could not receive surgery, and thus continued to receive chemotherapy. Among the 6 patients with borderline cancers, 4 patients underwent resection, and 2 patients continued to receive chemotherapy after NACRT due to development of hepatic metastasis. For 1 patient with unresectable cancer, chemotherapy was continuously performed because CT also suggested that the cancer would be unresectable. However, since a partial response of 38% reduction was confirmed after additional administration of TS1, distal pancreatectomy with en-bloc celiac axis resection was performed, and no residual tumor (R0) could be achieved. In 50% of the patients whose cancer could be removed (3 out of 6 patients), downstaging was observed. In the evaluation of residual tumor, R0 was confirmed for 4 patients, and pathological residual tumor (R1) was confirmed for 2 patients, including 1 patient with residual tumor in the mesenteric left plexus avulsion area and 1 patient with residual tumor in the pancreatic cut end.

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Cesarean scar pregnancy (CSP) is a form of ectopic pregnancy in which implantation occurs in a scar due to a previous cesarean section. With the progression of pregnancy and growth of the gestational sac, the implantation site will rupture if the muscle layer covering the chorion is thin, resulting in massive bleeding. Thus, careful maternal management is necessary. We herein report our experience of a case of miscarriage in a woman with CSP.

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The patient was a 64-year-old woman who was referred to our hospital in February 2010 with the diagnosis of liver metastases from the ascending colon cancer after resection of the primary lesion. After two hepatectomies were performed, a computed tomography scan revealed multiple metastatic lesions in the chest in October 2012. Chemotherapy comprising SOX plus Cetuximab and FOLFIRI plus Cetuximab for pulmonary metastases of ascending colon cancer was commenced. A subsequent computed tomography scan in February 2013 revealed that the multiple pulmonary metastatic lesions had disappeared. A complete response of the pulmonary metastases of ascending colon cancer to SOX plus Cetuximab and FOLFIRI plus Cetuximab in was observed. The patient was still alive with no signs of recurrence 19 months after the start of chemotherapy. Conclusion: These results suggest that complete remission from colon cancer with pulmonary metastases can be obtained with chemotherapy alone when SOX or FOLFIRI plus Cetuximab are included in the regimen.

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Our hospital is located in the eastern area of Tokyo. Despite being a small hospital, it has departments of surgery, orthopedics, neurosurgery and internal medicine, and it is responsible for emergency medical care in the region. The number of ambulances that came to our hospital is more than 2,000 per years. Starting from three years ago, our hospital participate in the training of residents belonging to the hospital of Nihon University School of Medicine in the fields of community medical care and general surgery. Seventeen residents have been trained for a total of 24 months in our hospital. During the short-term training, we have highlighted the following points when we are teaching residents. First, our educational goal is to identify patients with serious conditions even if they appear to have mild illness at the first glance. In particular, we emphasize that we can obtain important information from the interview of patients and their family, and that minor changes in the vital signs also suggest important changes in their medical conditions. In the training program, residents also take on surgical cases so they are able to experience the pleasure of surgical care.

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