Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy

Low-dose aspirin(LDA) is clinically used for the prevention of cardiovascular and cerebrovascular events with the advent of an aging society.On the other hand,a very low dose of aspirin(10 mg daily) decreases the gastric mucosal prostaglandin levels and causes significant gastric mucosal damage.The incidence of LDAinduced gastrointestinal mucosal injury and bleeding has increased.It has been noticed that the incidence of LDA-induced gastrointestinal hemorrhage has increased more than that of non-aspirin non-steroidal anti-inflammatory drug(NSAID)-induced lesions.The pathogenesis related to inhibition of cyclooxygenase(COX)-1 includes reduced mucosal flow,reduced mucus and bicarbonate secretion,and impaired platelet aggregation.The pathogenesis related to inhibition of COX-2 involves reduced angiogenesis and increased leukocyte adherence.The pathogenic mechanisms related to direct epithelial damage are acid back diffusion and impaired platelet aggregation.The factors associated with an increased risk of upper gastrointestinal(GI) complications in subjects taking LDA are aspirin dose,history of ulcer or upper GI bleeding,age > 70 years,concomitant use of non-aspirin NSAIDs including COX-2-selective NSAIDs,and Helicobacter pylori(H.pylori) infection.Moreover,no significant differences have been found between ulcer and non-ulcer groups in the frequency and severity of symptoms such as nausea,acid regurgitation,heartburn,and bloating.It has been shown that the ratios of ulcers located in the body,fundus and cardia are significantly higher in bleeding patients than the ratio of gastroduodenal ulcers in patients taking LDA.Proton pump inhibitors reduce the risk of developing gastric and duodenal ulcers.In contrast to NSAIDinduced gastrointestinal ulcers,a well-tolerated histamine H2-receptor antagonist is reportedly effective in prevention of LDA-induced gastrointestinal ulcers.The eradication of H.pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding.Continuous aspirin therapy for patients with gastrointestinal bleeding may increase the risk of recurrent bleeding but potentially reduces the mortality rates,as stopping aspirin therapy is associated with higher mortality rates.It is very important to prevent LDA-induced gastroduodenal ulcer complications including bleeding,and every effort should be exercised to prevent the bleeding complications.

Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: Key immunohistochemical profiles for differential diagnosis

AIM To reveal better diagnostic markers for differentiating neuroendocrine tumor(NET) from solid-pseudopapillary neoplasm(SPN), focusing primarily on immunohistochemical analysis.METHODS We reviewed 30 pancreatic surgical specimens of NET(24 cases) and SPN(6 cases). We carried out comprehensive immunohistochemical profiling using 9 markers: Synaptophysin, chromogranin A, pancytokeratin, E-cadherin, progesterone receptor,vimentin, α-1-antitrypsin, CD10, and β-catenin.RESULTS E-cadherin staining in NETs, and nuclear labeling of β-catenin in SPNs were the most sensitive and specific markers. Dot-like staining of chromogranin A might indicate the possibility of SPNs rather than NETs. The other six markers were not useful because their expression overlapped widely between NETs and SPNs. Moreover, two cases that had been initially diagnosed as NETs on the basis of their morphological features, demonstrated SPN-like immunohistochemical profiles. Careful diagnosis is crucial as we actually found two confusing cases showing disagreement between the tumor morphology and immunohistochemical profiles.CONCLUSION E-cadherin, chromogranin A, and β-catenin were the most useful markers which should be employed for differentiating between NET and SPN.

Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding

AIM: To investigate the clinical differences between small intestinal injuries in low-dose aspirin(LDA) users and in non-steroidal anti-inflammatory drug(NSAID) users who were examined by capsule endoscopy(CE) for obscure gastrointestinal bleeding(OGIB). METHODS: A total of 181 patients who underwent CE for OGIB were included in this study. Based on clinical records, laboratory data such as hemoglobin levels, major symptoms, underlying diseases, the types and duration of LDA and NSAID use, and endoscopic characteristics of CE were reviewed.RESULTS: Out of a total of 45 cases of erosive lesions, 27 cases were taking LDA or NSAIDs(7 were on NSAIDs, 9 were on LDA alone, 9 were on LDA and thienopyridine, and 2 were on LDA and warfarin).The prevalence of ulcers or erosion during chronic use of LDA, LDA and the anti-platelet drug thienopyridine (clopidogrel or ticlopidine), and NSAIDs were 64.3%, 80.0%, and 75.0%, respectively. Erosive lesions were observed predominantly in chronic LDA users, while ulcerative lesions were detected mainly in NSAID users. However, concomitant use of thienopyridine such as clopidogrel with LDA increased the proportion of ulcers. The erosive lesions were located in the whole of the small intestine(jejunum and ileum), whereas ulcerative lesions were mainly observed in the ileum(P < 0.05). CONCLUSION: Our CE findings indicate that chronic LDA users and NSAID users show different types and locations of small-bowel mucosal injuries. The concomitant use of anti-platelet drugs with LDA tends to exacerbate the injuries from LDA-type to NSAID-type injuries.

Prolonged survival in patients with hand-foot skin reaction secondary to cooperative sorafenib treatment

BACKGROUND Sorafenib is an oral drug that prolongs overall survival(OS)in patients with hepatocellular carcinoma.Adverse events,including hand-foot skin reaction(HFSR),lead to permanent sorafenib discontinuation.AIM To clarify the association between interventions for adverse events and patient prognosis.METHODS We performed a retrospective,multicenter study of patients treated with sorafenib monotherapy between May 2009 and March 2018.We developed a mutual cooperation system that was initiated at the start of sorafenib treatment to effectively manage adverse events.The mutual cooperation system entailed patients receiving consultations during which pharmacists provided accurate information about sorafenib to alleviate the fear and anxiety related to adverse events.We stratified the patients into three groups:Group A,patients without HFSR but with pharmacist intervention;Group B,patients with HFSR and pharmacist interventions unreported to oncologists(nonmutual cooperation system);and Group C,patients with HFSR and pharmacist interventions known to oncologists(mutual cooperation system).OS and time to treatment failure(TTF)were evaluated using the Kaplan-Meier method.RESULTS We enrolled 134 patients(Group A,n=41;Group B,n=30;Group C,n=63).The median OS was significantly different between Groups A and C(6.2 vs 13.9 mo,p<0.01)but not between Groups A and B(6.2 vs 7.7 mo,P=0.62).Group A vs Group C was an independent OS predictor(HR,0.41;95%CI:0.25-0.66;P<0.01).In Group B alone,TTF was significantly lower and the nonadherence rate was higher(P<0.01).In addition,the Spearman’s rank correlation coefficients between OS and TTF in each group were 0.41(Group A;P<0.01),0.13(Group B;P=0.51),and 0.58(Group C;P<0.01).There was a highly significant correlation between OS and TTF in Group C.However,there was no correlation between OS and TTF in Group B.CONCLUSION The mutual cooperation system increased treatment duration and improved prognosis in patients with HFSR.Future prospective studies(e.g.,randomized controlled trials)and improved adherence could help prevent OS underestimation.

Intravesical Non-Alkalinized Lidocaine Instillation for Interstitial Cystitis/Bladder Pain Syndrome Patients

Purpose: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Patients and methods: Five female patients (40 - 71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0 - 7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient's requirements and symptoms. The treatment effect was evaluated comparing O'Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of lidocaine therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O'Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis findings on cystoscopy disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder-filling pain decreased from 7 to 3 as a visual analog scale score. One patient complained palpitation at 11th instillation and abandoned treatment thereafter, otherwise, none of these patients showed side effect concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis/bladder pain syndrome patients were an easy, safe and effective treatment.

Basal Cell Proliferation Induced by Chlormadinone Acetate Suggests Stem Cell Transformation of Prostatic Cells

Introduction and Objective: Epithelial to Mesenchymal transition (EMT) at the first hormonal therapy is thought to play an essential role in obtaining castrate resistance for hormone naive prostate cancer. So we studied EMT of prostatic cells after exposing various hormonal agents using transurethral resection (TUR) specimens. Patients and Methods: TUR specimens without hormonal use (4 cases), specimens after three weeks of chlormadinone acetate (CMA) (9 cases), specimens after average six months of dutasteride (3 cases), and specimens two weeks after initial use of degarelix (3 cases) were studied using HE and immunohistochemical staining with prostate specific antigen (PSA), prostatic stem cell markers such as CD44, CD117, CD133 and Vimentin. Results: Specimens treated with CMA showed acinar dilatation and atrophy of glandular cells. Specimens treated with dutasteride showed marked decrease of gland and specimens treated with degarelix showed decrease of glandular cells. PSA was stained all of the prostatic glandular cells in all specimens. CD44 was stained at basal cells in normal prostatic tissue without hormones, however in hormone treated specimens, basal cells elongate and some glandular cells were also stained by CD44, especially in CMA treated specimens. Only small numbers of infiltrating cells in interstitial tissue positively stained with CD 117 and CD 133 in all specimens. Vimentin was stained in all mesenchymal interstitial cells. Conclusion: Elongation of basal cells and increased sensitivity to CD44 in glandular cells, especially treated with CMA, were thought to the result of EMT of prostatic glandular cells.

Cartilage Repair by Joint Distraction and Motion Using an External Fixator for Massive Cartilage Defect

The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of massive articular cartilage defect in order to evaluate the effectiveness of using joint distraction and motion with a ring-type external fixator. This external fixator has a hinged joint with a center of rotation along the femoral transepicondylar axis, which allows the knee joint to freely flex and extend. Mesenchymal cells from bone marrow, induced by spongialization, were differentiated into mature chondrocytes and formed hyaline-like cartilage as a result of joint distraction and movement. The transplantation of autologous cells expanded from bone-marrow-derived mesenchymal cells, concentrated autologous bone marrow aspirate, and concentrated autologous peripheral blood cells were all effective in promoting cartilage repair. The quality of the cartilage after long-term joint distraction for 6 months was inferior to that after 12 weeks. In general, weight bearing on the regenerated cartilage promoted cartilage repair, although this effect differed based on when gradual weight bearing was begun. Specifically, gradual weight bearing beginning at 9 weeks produced superior results to that beginning at 6 weeks. Our methods provide an optimal environment for cartilage regeneration.

Enhancement of HIFU Effect by Simultaneous Short Course Degarelix for Early Stage Prostate Cancer: A Pilot Study

Objective: To obtain complete prostatic cell death in the treatment of early stage prostate cancer by High Intensity Focused Ultrasound (HIFU) therapy, we use Degarelix (GnRH antagonist) twice simultaneously. Patients and Methods: The first Degarelix subcutaneous injection was made two weeks before HIFU therapy, and second Degarelix was applied two weeks after the HIFU therapy. No additional maintenance Degarelix was used. To confirm the apoptosis induced by Degarelix, specimens obtained by transurethral resection simultaneously on HIFU were stained with caspase 3 and TUNEL. PSA was monitored every three months after this combination therapy as long as two years. These PSA values were compared with those who previously treated with HIFU without Degarelix. Results: Nine T1cN0M0 prostate cancer patients were enrolled to “HIFU + Degarelix” therapy. Pre treatment mean PSA level was 6.11 ± 1.83 ng/ml (SD), and PSA 3 months after the treatment was 0.02 ± 0.02. These low PSA levels continued thereafter (0.16 ng/ml ± 0.19 at 24 months). The mean pretreatment PSA level of the 34 patients underwent HIFU without Degarelix was 11.07 ± 13.9 ng/ml, 3 months post HIFU was 1.68 ± 3.04, (2.80 ± 3.97 at 24 months). Caspase 3 and TUNEL were positive on the glandular cells in TUR specimens of “HIFU + Degarelix” patients, suggesting Degarelix induced apoptosis. Conclusion: Although the number of our patients was small, the results of “Short course Degarelix + HIFU” would be promising for better long-term outcome than HIFU mono-therapy.

Evaluation of gut dysbiosis using serum and fecal bile acid profiles

Dysbiosis in the intestinal microflora can affect the gut production of microbial metabolites,and toxic substances can disrupt the barrier function of the intestinal wall,leading to the development of various diseases.Decreased levels of Clostridium subcluster XIVa(XIVa)are associated with the intestinal dysbiosis found in inflammatory bowel disease(IBD)and Clostridium difficile infection(CDI).Since XIVa is a bacterial group responsible for the conversion of primary bile acids(BAs)to secondary BAs,the proportion of intestinal XIVa can be predicted by determining the ratio of deoxycholic acid(DCA)/[DCA+cholic acid(CA)]in feces orserum.For example,serum DCA/(DCA+CA)was significantly lower in IBD patients than in healthy controls,even in the remission period.These results suggest that a low proportion of intestinal XIVa in IBD patients might be a precondition for IBD onset but not a consequence of intestinal inflammation.Another report showed that a reduced serum DCA/(DCA+CA)ratio could predict susceptibility to CDI.Thus,the BA profile,particularly the ratio of secondary to primary BAs,can serve as a surrogate marker of the intestinal dysbiosis caused by decreased XIVa.

Anatomical backgrounds on gas exchange parameters in the lung

Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit.Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung periphery.However, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anatomically morbid states in alveolar walls:type-1abnormality defined by decrease in both D_(LCO) and K_(CO); type-2 abnormality by decrease in D_(LCO) but increase in K_(CO); type-3 abnormality by decrease in D_(LCO) but restricted rise in K_(CO); and type-4 abnormality by increase in both D_(LCO) and K_(CO).

Basal Cell Hyperplasia Observed at Biopsy Specimens after HIFU Therapy: Implication of Stemness for Organ Regeneration

Prostatic basal cell is thought to play a pivotal role in hyperplastic change or carcinogenesis of prostate by their proliferation and stem cell transformation. We investigated stem cell transformation of basal cell hyperplasia observed at biopsy specimens after High Intensity Focused Ultrasound (HIFU) therapy for early stage prostate cancer. Patients and Methods: Basal cell hyperplasia was observed at biopsy specimens in two patients after HIFU therapy. Of these patients, one showed cancer recurrence. Specimens were studied with usual HE, and immunohistochemical studies for prostate specific antigen (PSA), stem cell markers such as CD44, CD117 (c-kit), CD133 and Vimentin. Results: Both basal cell hyperplasia cases indicated PSA (-), CD44 (++), CD117 (-), Vimentin (-) and one specimen showed CD133 (++). Basal cell hyperplasia was presumed to appear during the regeneration process of normal prostate tissue after HIFU therapy, when basal cell proliferated and transformed to acinal cells through epithelial to mesenchymal transition.

Effect of pulmonary rehabilitation on oxidative stress in patients with pulmonary diseases

Exercise-training-based pulmonary rehabilitation has been confirmed to be effective in improving the activities of daily living (ADL) and relieving the dyspnea of chronic obstructive pulmonary disease (COPD) patients. Exercise training increases the antioxidant capacity of COPD patients, but since strenuous exercise and acute exercise loading have the opposite effect and increase oxidative stress, it is important to establish exercise training conditions that efficiently raise antioxidant capacity without increasing oxidative stress. Research on oxidative stress during exercise training by COPD patients has been pursued from that standpoint, but in recent years the targets of research on respirator diseases other than COPD have been expanding. In this article we will therefore review the results of research that has been conducted thus far on the effect of pulmonary rehabilitation on oxidative stress, including the results obtained at our own institution.

Tips for Office-Based Transurethral Biopsy and Fulguration as a Treatment of Tiny Bladder Tumors

Among the patients who underwent outpatient cystoscopy as a follow up of bladder cancer, quite a few patients are observed tiny papillary lesions suspicious for tumor recurrence. Transurethral biopsy and/or resection under spinal or general anesthesia in a hospitalized setting are the usual procedures for this kind of patients, even though these procedures are simple and brief. We tried transurethral biopsy and fulguration as a treatment for very small bladder tumor in an outpatient setting and here describe tips for these procedures. Olympus CYF-VA flexible cystoscope, a 3 Fr. diathermy probe, monopolar electrosurgical unit were used. No additional anesthetics except for 10 ml of 2% Xylocaine gel applied to (male patient’s) urethra as an initial flexible cystoscopic procedure, was required for tumor treatment. Distilled water was used as an irrigation fluid. Experienced tips of the procedures to avoid tumor recurrence are as follows: tumor should be one location, size of the tumor should be less than 5 mm, bladder should be washed several times after the fulguration with hundreds ml of distilled water. We conclude that outpatient biopsy and fulguration for tiny bladder tumor is effective and less invasive procedure as a treatment of bladder cancer patients.

Upfront Docetaxel with LH-RH Antagonist for Metastatic Hormone Sensitive Prostate Cancer Considering Epithelial to Mesenchymal Transition

Objective: Upfront docetaxel use for hormone naïve advanced prostate cancer is reported that it successfully delayed the progression to hormone refractory stage, though the adequate methodology to obtain the maximum effect is unclear. We investigated these issues from our experiences of upfront docetaxel use with LH-RH antagonist for metastatic hormone sensitive prostate cancer, aiming at the prevention of epithelial-mesenchymal transition (EMT) for apoptosis tolerance. Patients and Methods: Of 31 stage IV new prostate cancer patients treated with upfront docetaxel and LH-RH antagonist (Degarelix), 25 patients who could be followed more than 12 months (mean 36.2 months) were analyzed. Docetaxel was used two to three courses basically 75 mg/m2 dose initializing two weeks after the induction of first Degarelix. Results: The clinical course was divided clearly to two groups according to prostate specific antigen (PSA) values. Of 25 patients, 12 patient’s PSA did not decrease below 0.1 ng/ml within 6 months (group A) and gradually rose afterwards. PSA in another 13 patients (group B) decreased below 0.1 within 6 months and kept below 0.1 during the follow up period. Although statistically not significant, the initial group A’s PSA was higher than group B’s (average 1308 and 353 ng/ml), however, number of metastasis, Gleason sum, and bone metastatic extent of disease showed no difference between them. Among group B patients, 7 cases had only upfront docetaxel and hormonal therapy, and some of these patients showed only atrophic gland and fibrotic tissue at second prostate biopsy (specimens after more than two years of therapy), suggesting complete response. Conclusion: Our study suggested that PSA value at 6 months may predict the outcome of whole therapy. Patients showing PSA less than 0.1 ng/ml at 6 months and requiring no therapy other than docetaxel and hormone may be induced to complete response. Upfront docetaxel with LH-RH antagonist may prevent EMT for obtaining apoptosis tolerance, in case the patient does not have the castration-resistant clone at the beginning of the therapy (group B).

Bicarbonate Attenuates Irinotecan-Induced Cytotoxicity through Regulation of Both Extracellular and Intracellular <i>pHs</i>in Intestine Cell Line

The anti-cancer therapy of irinotecan (CPT-11) is often limited due to severe late-onset diarrhea. Because the higher toxic form of CPT-11/its active metabolite (SN-38) is produced at acidification, the usefulness of oral sodium bicarbonate treatment against the CPT-11/SN-38-induced intestinal injuries and diarrhea has been confirmed. However, the roles of bicarbonate have been suggested to affect not only intestinal pH environment but also intracellular pH and CPT-11/SN-38 dynamics. The present study proposed to clarify the hypothesis in CPT-11/SN-38-exposed colon cell line in various pH conditions adjusted by bicarbonate. HT29 cell pre-exposed to ~1.0 μM SN-38 lactone or carboxylate forms was incubated at different pH adjusted by either bicarbonate or HCl/NaOH. The degrees of SN-38-induced cell injury depended on the higher proportion of the toxic form (lactone) of SN-38 rather than mere pH condition of medium. Apoptosis and cell injury induced by SN-38 were significantly inhibited by bicarbonate in a dose-dependent manner. Intercellular pH acidification induced by SN-38 was significantly prevented by 30 mM bicarbonate. Cell cytotoxicity of SN-38 depended on not only extracellular but also intracellular pH that converts the SN-38 form, while the intracellular acidification was prevented by bicarbonate. The multiple regulations of bicarbonate on both exracellular and intracellular pH would be essential mechanism against intestinal cell injury by CPT-11/SN-38.

Classical regression equations of spirometric parameters are not applicable for diagnosing spirometric abnormalities in adipotic adults

The prevalence of overweighing and obese adults (defined as "adipotic" adults),has markedly increased over the world. A remarkable increase in the adipotic population urgently needs developing the regression equations for predicting spirometric parameters (SPs), which are specifically applicable to adipotic adults.Unfortunately, however, the reliable equations suitable for adipotic adults have not been reported to date. Recently, Yamaguchi et al have proposed the quantitative method to estimate the effects of adiposity on deciding the SPs incorporating with age-specific contributions of various explanatory,independent variables such as age (A), standing height (H), body weight (BW),and fat fraction of body mass(F). Extending the method proposed by Yamaguchi et al, we attempted to elaborate the novel regression equations applicable for diagnosing the spirometric abnormality in adipotic adults. For accomplishing this purpose, never-smoking, adipotic adults with body mass index (BMI) over 25 kg/m^2 and no respiratory illness were recruited from the general population in Japan (n = 3696, including men: 1890 and women: 1806). Introducing the four explanatory variables of A, H, BW, and F, gender-specific and age-dependent regression equations that allowed for prescribing the SPs in adipotic adults were constructed. Comparing the results obtained for non-adipotic adults (i.e., those with normal BMI), the negative or positive impact of height on SPs was preserved in adipotic adults, as well. However, the negative impact of age on SPs was blunted in adipotic men and the positive effect of BW on SPs was impeded in adipotic men and women. The fat fraction of body mass-elicited negative impact on SPs vanished in adipotic women. These results indicate that the regression equations of SPs for adipotic adults differ significantly from those for nonadipotic adults, leading to the conclusion that the regression equations for nonadipotic adults should not be used while judging the spirometric abnormalities in adipotic adults.

Problems in Japan’s Aging Society from the Perspective of Lichen Sclerosus

We encountered 12 elderly patients with lichen sclerosus (LS), a relatively high percentage of whom were living with their families. There is a tendency to assume that elderly people living alone or older facility users with paralysis are more likely to require social care, but we note that elderly people living with their families are also likely to develop LS.

Sarcomatoid Carcinoma of the Urinary Bladder

The patient was a 62-year-old female with bladder carcinoma. TUR-BT was performed in March 2010, and the pathological finding was UC, G2 > G1, pTa. However, the cancer recurred in the urinary bladder 3 months after TUR-BT. Radical cystectomy was performed, and the disease was considered to have been cured, but metastasis developed in the skin, lung, liver, and bone several months after surgery. Chemotherapy was ineffective, and the patient died. On pathological examination at the time of radical cystectomy, the lesion was sarcomatoid carcinoma of the urinary bladder. Although the prognosis associated with this carcinoma is known to be poor, the possibility of underestimation on preoperative staging cannot be ruled out from the cause, in addition to the insufficiency of the current therapeutic strategy.

Sarcomatoid carcinoma of the penis

We encountered a 63-year-old male with a sarcomatoid carcinoma of the penis accompanied by metastasis to the bilateral inguinal lymph nodes and lungs. He noticed a penile mass, but neglected it. The mass rapidly increased in size, forming an ulcer, and began to disintegrate. He visited our hospital 4 months after noticing the mass. After cystostomy and blood transfusion, surgical resection was performed. A diagnosis of a squamous cell carcinoma with a sarcomatoid carcinoma of the penis was made. After the operation, best supportive care (BSC) was selected. We made efforts to maintain his quality of life (QOL), and he died 3 months after the operation.

Dual-Energy Computed Tomography for the Diagnosis of Urethral Foreign Body: A Case Study

Foreign body insertion in the urethra and bladder is not uncommon and has been reported in many studies to date. However, since foreign bodies are often accidentally introduced into the urethra and bladder during masturbation, they take a variety of shapes and sizes. Furthermore, patient self-reports are typically unreliable as many patients feel ashamed;thus, appropriate preoperative diagnosis is critical. Diagnosis of foreign body insertion in the urethra and bladder is performed using imaging modalities such as abdominal X-ray and computed tomography (CT). However, single-energy CT (SECT) is not sufficient in detecting foreign bodies in some cases. In the present study, we report a successful preoperative identification of urethral foreign body in a patient using dual-energy CT (DECT).