A 76-year-old female, who had been under observation for interstitial pneumonia due to rheumatoid arthritis for over 10 years, was admitted to our hospital because of dyspnea. Her chest CT showed consolidation in both lower lung fields positive for FDG-PET. Transbronchial lung biopsy was performed and diffuse large B-cell lymphomas were histologically observed. The patient was treated with 6 cycles of Rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and has remained disease free for over three years. This is the first case of primary pulmonary lymphoma developing during the clinical course of interstitial pneumonia associated with rheumatoid arthritis in patients after cessation of methotrexate or with Sjogren syndrome.
An 80-year-old woman was admitted because of constipation and abdominal pain. Gastrographin enema showed multiple diverticula of the wall from the sigmoid colon to the rectosigmoid junction of the rectum and stenosis of the sigmoid. Colonoscopy showed mucosal edema, but no atypical glands were seen in the mucosa by biopsy. We considered that conservative treatment was insufficient and performed a colectomy. The resected specimen revealed multiple diverticula and wall thickening at a maximum of 1cm. Pathological examination revealed infiltration of inflammatory cells around the diverticula, thickening of the proper muscular layer, and fibrosis of the submucosal and subserosal layer. We concluded that the stenosis had been caused by repeated diverticulitis in addition to the thickening of the muscular layer. No malignancy was seen. Bowel stenosis due to diverticulitis requiring surgery is rare. We report this case with a discussion of the diverticulitis literature.
Purpose : Sutureless abdominal wall closure (SC) for gastroschisis is cosmetically superior to surgical closure. We compared the two procedures (conventional surgical closure and SC) in terms of clinical outcome. Methods : Between 1993 and 2011, 15 cases of gastroschisis were treated in our institution. Medical records were reviewed retrospectively with regard to gestational age, birth weight, procedure, operating time, duration of respiratory support (RS), time to start feeding (SF), time to full feeding (FF) and the length of hospital stay (HS). The parameters were compared in each group. Results : Of the 15 patients, 10 had primary closure either by conventional surgical closure (Group A1, n=8) or SC (Group A2, n=2). Five had delayed closure either by surgical closure (Group B1, n=2) after placement of the silastic silo or by SC (Group B2, n=3) after placement of the silo using the Wound retractor®. In primary closure, SF, FF and HS were shorter in group A2. In delayed closure, SF, FF and HS were shorter in group B2 than in group B1. Conclusion : SC is likely to improve postoperative clinical outcome in both primary and delayed closure compared to conventional surgical closure.