We investigated the correlation between the incidence of anatomical variations in the nasal cavity and mucosal inflammation in the paranasal sinuses, using computed tomography (CT). In total, 239 patients (478 sides; 138 men and 101 women; age range, 8-89 years) underwent coronal plane CT for screening from November 2001 to October 2006. Patients with facial trauma, paranasal sinus carcinoma, inverted papilloma, or previous sinus surgery were excluded from this study. We evaluated the incidence of agger nasi air cells, Haller's cells, middle and superior turbinate pneumatization, paradoxically curved uncinate processes, paradoxically curved middle turbinates, and septal deviation. The mucosal condition and ostiomeatal complex were evaluated by the Lund-Mackay staging system, and correlations between groups were analyzed using Mann-Whitney's U tests. The incidence of nasal septal deviation was 14.6% and the incidences of agger nasi air cells, concha bullosa (pneumatization of the middle nasal turbinate) and Haller's cells were 47.7%, 22.4% and 10.7%, respectively. Paranasal CT showed partial or total opacification of the sinuses in approximately 40% of the anterior and posterior ethmoid and maxillary sinuses. Concha bullosa increased the CT opacification of the paranasal sinuses, except for the sphenoid sinus. There was no significant association between the occurrence of concha bullosa and nasal septal deviation. Our results suggest anatomical variations in the nasal cavity induce mucosal inflammation in the paranasal sinuses.

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This study aimed to evaluate the frequency, distribution, and corresponding histology of MUC1 expression in colorectal cancer and examine its association with clinicopathological factors. MUC1 expression was confirmed in 86 of 169 surgically resected colorectal cancers (51%), although the ratio of MUC1-positive cells was less than 5% in 33 cases (20%), 5-50% in 46 cases (27%), and greater than 50% in only 7 cases (4%). None or less than 5% of MUC1 expression cases were classified as L-group cancers (116 cases, 69%), while cancers showing higher than 5% expression were classified into the H-group (53 cases, 31%). Analysis of the intratumoral distribution of positive cells in the H-group cases showed MUC1 expression distributed predominantly in the upper layers in 3 cases (6%), in the lower layers in 18 cases (34%), and in all layers in 32 cases (60%). MUC1 expression was observed in various histomorphological cancer forms, but the most frequent expression was noted in the monolayer cuboidal (pancreatobiliary-type) neoplastic glands. Considering the relationship between MUC1 expression and clinicopathological factors, H-group cases demonstrated significantly larger lesions showing a greater number of ulcerated-type cancers, deeper invasion, poorer differentiation, higher frequency of budding, and higher rate of lymph node metastasis than L-group cancers. Furthermore, there was a difference of 10% between the H-group and L-group with regard to the frequency of relapse/tumor mortality three years after surgery. In colorectal cancer, MUC1 expression increases with progression of the tumor indicating that it is one of the useful indicators of malignancy and may facilitate appropriate treatment regimens; however, as its expression is heterogeneous and localized, it will be necessary to confirm the state of MUC1 expression by case.

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This study aimed to establish quantitative diagnosis and grading of the fatty liver using histogram analysis of ultrasonographic image, body measurements (body mass index, body fat percentage) and laboratory data. A total of 373 subjects (212 men; age, 46.1 ± 8.7 years and 161 women; age, 45.6 ± 7.5 years) who underwent a health check service were enrolled in this study. The relationship between body measurements, laboratory data and the L-value (the most frequent gradient resulting from the histogram analysis of the ultrasonographic image) was assessed. About 70% of subjects were healthy at L/K-value (the difference of the L-value between the liver and the right renal cortex) ≤ 3 and about 50% at L/K-value = 4. Healthy subjects were dominant at L/K-values up to 4-5. Less than 30% of subjects were healthy at a L/K-value of 5. More than 50% of subjects with a L/K value of 7 suffered from both liver damage and dyslipidemia and less than 5% of subjects with L/K-value ≥ 8 were healthy. Body mass index and body fat percentage had little effect on these results unless the subjects were excessively obese or thin. Based on the evaluation above, we propose the L/K value criteria for detecting and grading of the fatty liver as follows: Normal, ≤ 3; borderline, = 4; mild fatty liver, 5-6; moderate fatty liver, 7-8; severe fatty liver, ≥ 9 or when histogram analysis fails to evaluate the liver/kidney contrast due to strong attenuation of echogenicity, such as “bright liver”. There was good agreement between these criteria and the subjective opinion of the operator during actual ultrasound fatty liver diagnosis. The histogram index could provide operator-independent quantitative diagnosis and grading of the fatty liver, which may serve as an efficient tool for diagnosis and follow up of patients.

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Background Extranodal metastasis (EM) has been reported in carcinomas of many organs. However, the clinicopathological significance of EM in squamous cell carcinoma of the esophagus remains unclear, and this study sought to clarify this issue. Methods This study included 220 patients who underwent an esophagectomy with lymphadenectomy for primary esophageal carcinoma from 1996 to 2008. EM was defined as the presence of cancer cells in the soft tissue that were discontinuous with the primary lesion, or in the perinodal soft tissue distinct from the lymph nodes. Results EM was detected in 25 (9.6%) of the 220 patients, and in 56 (0.7%) of the 8,186 nodules retrieved as ‘lymph nodes’. The incidence of EM was significantly higher in patients who had tumors of a larger size (diameter ≥ 4 cm), lymphatic vessel invasion, lymph node metastasis, a high pathological stage, infiltrative growth pattern, or a high pT-stage. The 5-year overall survival rates in N0-1 patients with EM were significantly lower than in the patients without EM (P = 0.005). Conclusion EM is closely associated with the development and aggressiveness of esophageal carcinoma, and the presence of EM can be useful for predicting prognosis after surgery in N0-1esophageal carcinoma patients.

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A 52-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension in July 2011. She had myasthenia gravis, but did not have any surgical history. Clinical examination showed a right lower abdominal mass, abdominal distension, decreased bowel sounds, and rebound tenderness in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A gastrografin enema image of the colon showed a 30-mm filling defect in the ascending colon. The patient underwent resection of the intussuscepted intestine by single-incision laparoscopic surgery (SILS). The resected specimen contained a round tumor measuring 35 × 35 × 20 mm, which was diagnosed histopathologically as lipoma of the terminal ileum. The patient remains asymptomatic eight months after surgery.

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We report a case of seat belt trauma with delayed ischemic ileal obstruction. A 62-year-old woman presented with symptoms and signs of bowel obstruction three weeks after an automobile traffic accident. A plain radiograph of the abdomen showed dilated small bowel loops with air fluid levels that were consistent with intestinal obstruction. Enhanced computed tomography clearly demonstrated a stenotic ileal loop with mural thickening that was associated with a mesenteric hematoma. Upper endoscopy revealed an ulcer of the ischemic ileal obstruction. The patient underwent resection of the stenotic ileal loop by single-incision laparoscopic surgery. The stenotic ileal loop was located 120 cm oral side from the terminal ileum. In gross finding, the wall of stenotic ileal loop was thickened and the adjacent mesentery was shortened with a hematoma. The mucosa of the ischemic ileal obstruction showed ulcerative changes. The abnormal ileal loop, which was 15 cm in length, was resected. Postoperative recovery was uneventful.

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Herein, we report on an unusual case of polypoid mixed hemangioma of the sigmoid colon. An 85-year-old woman who underwent colonoscopic examination was found to have a smooth, red polypoid tumor, 6mm in diameter, in the sigmoid colon. The polyp was resected endoscopically. Microscopically, the polyp contained two pathologic components: (i) adenomatous proliferative glands as the epithelial component; and (ii) mixed hemangioma as the mesenchymal component. On the basis of these findings, a pathological diagnosis of angioadenomatous polyp was made. Although seven previous cases of polypoid hemangioma located in the submucosa have been reported in the literature, the present case is the first in which the hemangioma is localized only in the mucosa. The mixed hemangioma may be the pathogen stimulating the adenomatous proliferation of the glands.

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In this report, we present a case of intestinal obstruction secondary to a strangulated obturator hernia in an elderly woman. An 88-year-old woman was admitted to our hospital because she had been experiencing abdominal pain and vomiting for 24h. Her abdomen was distended, and bowel sounds indicating obstruction were heard on auscultation. Diffuse abdominal tenderness was present, but no palpable masses were apparent. The diagnosis of an obturator hernia was confirmed preoperatively by computed tomography. During the emergency laparotomy, the incarcerated intestine was reduced and removed. The obturator foramen was repaired using a simple suture. The patient recovered completely and was discharged seven days after the surgical procedure because no postoperative complications occurred. An early diagnosis and prompt surgical treatment are important to reduce the morbidity and mortality associated with an obturator hernia.

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A rare autopsy case of multiple jejunal diverticula showing severe malabsorption is reported. A 56-year-old man was admitted due to vomiting and leg edema. On admission, his height was 160cm, his body weight was 39kg, and laboratory data revealed severe hypoproteinemia (TP: 4.0g/dl, ALB: 2.1g/dl). On the 14^th day of admission, agonal breathing and disturbance of consciousness occurred after massive vomiting of gastric juice, and the patient died of respiratory failure. At autopsy, on abdominal sectioning, multiple diverticula situated on the mesenterium side of the enteron extending 70cm in length from the proximal jejunum were identified. However there were no findings suggesting perforation or diverticulitis. Histologically, the diverticula were lined by ordinal jejunum mucosa associated with muscularis mucosa, but the muscularis propria was not involved in the diverticular walls. The diverticula were identified as false diverticula. In both lower lungs, aspiration pneumonia was widely seen. The cause of death was considered to be aspiration pneumonia due to the vomiting caused by multiple jejunal diverticula.
Only 16 case reports of multiple jejunal diverticulosis in Japan could be found in the literature however most of the reported complications were perforation and diverticulitis, and there were no reports of malabsorption. Therefore, the present case is significant concerning the cause of malabsorption in routine explorations.

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