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A 70-year-old man was diagnosed with middle and lower thoracic esophageal squamous cell carcinoma. A computed tomography(CT)scan revealed multiple pulmonary metastases. The clinical stage was T3N1M1, Stage Ⅳb. After esophageal stent placement was performed to alleviate strong stenotic symptoms, cisplatin/5-fluorouracil(CDDP/5-FU)therapy was introduced, and 8 courses were completed. Four additional courses of 5-FU monotherapy were then administered. Following systemic chemotherapy, CT scans showed no evidence of lung metastases. About a year after the initial treatment, the patient underwent a thoracoscopic esophagectomy. Postoperatively, he was followed up without treatment and has remained alive for 1 year and 4 months without any recurrence.

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INTRODUCTION AND IMPORTANCE: Gastric perforation due to a hiatal hernia is a rare cause of acute abdominal pain that often requires surgical intervention. Conservative management for this condition is an effective option in certain cases, although fewer reports of this exist. Herein, we report a unique case of gastric perforation caused by a recurrent hiatal hernia that was successfully treated with conservative management. CASE PRESENTATION: A 74-year-old man developed a high fever and an elevated inflammatory response on the third day after a laparoscopic paraesophageal hernia repair using a mesh. Computed tomography confirmed the recurrence of the hiatal hernia, with gastric fundal prolapse into the mediastinum and surgical emphysema in the gastric wall. This was followed by a gastric perforation within the mediastinum. The patient was treated using an ileus tube through the perforation site. CLINICAL DISCUSSION: In similar cases, if the clinical symptoms are mild, there are no signs of serious infection, and the perforation remains in the mediastinum and can be appropriately drained, conservative treatment is considered an option. CONCLUSION: Under favorable conditions, conservative management can be an option for gastric perforation in patients with recurrent hiatal hernias, which is a serious potential postoperative complication.

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A 54-year-old man underwent laparoscopic distal gastrectomy with D2 lymph node dissection and ante-colic Roux-en-Y reconstruction for gastric cancer. The histopathological diagnosis was pT2N3aM0, pStage ⅢA, HER2 negative. After 8 courses of S-1 plus oxaliplatin as adjuvant chemotherapy, he was diagnosed as peritoneal dissemination and treated with ramucirumab(RAM)plus paclitaxel(PTX). On the 12th day of course 10, he visited to our hospital with abdominal pain. CT showed free air and massive ascites. Emergent surgery was performed under the diagnosis of gastrointestinal perforation. A small intestinal perforation in front of the jejunal limb near gastric-jejunal anastomosis was identified and there was no peritoneal dissemination. We performed partial resection of remnant stomach and jejunal limb by linear stapler and reconstruction by end to side gastric-jejunal anastomosis. Because the gastric and intestinal wall were quite fragile and RAM impaired wound healing as adverse event, we feared about leakage, but he had no major postoperative complications and discharged on the 33th day after surgery. After 24 courses of nivolumab as third-line chemotherapy, the peritoneal dissemination disappeared. He has been alive without recurrence for about 1 year since then.

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We developed a new inhalation exposure method to evaluate effects of synthetic cannabimimetics that are being distributed as new, unregulated drugs in the Tokyo area. We selected the commercial product "SOUTOU" containing AB-CHMINACA and 5F-AMB as the test drug and dried marshmallow (Althaea officinalis) leaves as the negative control. A half cigarette packed with dried marshmallow leaves or SOUTOU was ignited, then mainstream smoke from each was delivered to five mice in an exposure box. After the cigarettes were fully consumed, neurobehavioral observations and a catalepsy test were performed at 15, 30 and 60 min after exposure. The effluent air from the exposure box was poured into impingers containing acetonitrile (first impinger) and dimethyl sulfoxide (second impinger). The resulting solutions were analyzed to assess decomposition of the synthetic cannabimimetics. Mice exposed to SOUTOU smoke showed many excitement behaviors and some suppressive behaviors at 15, 30 and 60 min. These clearly included cannabimimetic specific pharmacological actions. Negative control mice also showed some suppressive behaviors at 15 min but these were attenuated at later times, nearly disappearing at 60 min. In addition, the behavioral effects observed in controls were less pronounced than those in SOUTOU exposed mice. The inhalation exposure method developed in our study would be effective for determining cannabinoid specific pharmacological effects of illegal drugs, as well as for assessing the presence of active compound(s) by comparing the test substance with a negative control.

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OBJECTIVES: First, we observed that copper and histidine levels were increased in the sera of undernourished women. The objective of this study was to clarify the reason for the increase in copper and histidine. Furthermore, we tried to determine the compound(s) to which the increased copper was binding, and examined the effect of the increased copper and histidine on lipid peroxidation. METHODS: We investigated young women's diets and took blood samples, and the contents of histidine in the sera were determined by HPLC. The contents of copper were determined by flameless atomic absorption spectroscopy. The subjects were classified into three groups according to the concentration of histidine in the sera. The contents of copper and lipid peroxide in the sera were compared among the high histidine group and the other groups. We also examined the ability of the complexes to prevent LDL oxidation induced by copper, using an in vitro assay. RESULTS: The contents of lipid peroxide were lower in the high histidine group than in the other groups. Furthermore, the complexes of histidine and copper inhibited the formation of peroxidized lipids in an in vitro assay. CONCLUSIONS: These results indicate that histidine masks copper, reducing oxidation reaction. They also suggest that the complexes are suited for plasma antioxidation, preventing oxidative modification of lipids in the sera of undernourished women. The increased histidine appeared to be an effective trap for active oxygen.

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