A few cases were reported in which second reconstructive operation on gastrointestinal tract for reflux esophagitis following the proximal gastrectomy was performed. But no previous report of the removal of anastomotic region for treating anastomotic stricture due to reflux esophagitis has appeared. Also, there are no reports on second operations to treat anastomotic strictures following proximal gastrectomy for esophageal varices. We report a case in which we obtained favorable results in treating an anastomotic stricture due to reflux esophagitis, which developed following a proximal gastrectomy for esophageal varices, by performing removal of the anastomotic region and resection of the remaining stomach with reconstruction by the Roux-en Y method.
Generally, primary pulmonary pleomorphic carcinoma is resistant to treatment and has a poor prognosis. We report a case of resected primary pulmonary pleomorphic carcinoma with long-term survival after multidisciplinary treatment.A 74-year-old man with a history of emphysema, pneumoconiosis, and chronic bronchitis presented with left lung nodule and left adrenal tumor based on computed tomography. We suspected clinical T1bN0M1b, stage IVB lung cancer. Adrenalectomy of the left adrenal tumor yielded a definitive diagnosis of pleomorphic carcinoma. Chemotherapy was performed despite the spontaneous regression of lung lesions. Since lung lesions re-enlarged 11 months after adrenalectomy, the left lower lobe was partially resected followed by chemotherapy. The lung lesion was the primary lesion of the adrenal tumor. There was no recurrence 100 months after the lung resection.The patient experienced long-term survival after multidisciplinary treatment. Both multidisciplinary treatment and immunological mechanisms caused spontaneous regression of the primary lesion.
This study aimed to assess the long-term outcomes of radiotherapy in patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Twenty-seven patients with Stage I gastric MALT lymphoma were treated with radiotherapy from 1999 to 2010. The median age was 65 years (range: 31-84). Fifteen patients were Helicobacter pylori-negative. Thirteen patients were treated with definitive radiotherapy alone. The other 14 patients who had refractory or residual disease following a prior treatment received salvage radiotherapy. The median dose of the radiotherapy was 30 Gy in 20 fractions (range: 30-39.5 Gy). The median follow-up period was 121 months (range: 8-176 months). The 5- and 10-year overall survival rates for all patients were 92% and 87%, respectively. No patients died from MALT lymphoma. Three patients died of other diseases at 8, 33 and 74 months after radiotherapy (myocardial infarction, pneumonia and hepatocellular carcinoma, respectively). No cases of local recurrence were observed during the follow-up period. There were no serious late gastric, liver or kidney complications during a median follow-up period of over 10 years. Two patients remain alive with distant metastases: a lung metastasis and an abdominal lymph node metastasis at 104 months and 21 months after radiotherapy, respectively. Excellent long-term local control was observed in patients with localized gastric MALT lymphoma after radiotherapy. However, lifelong follow-up should be conducted to detect cases of late recurrence, especially distant metastases.
We experienced 2 infants in whom octreotide acetate was effective on intractable chylothorax after surgery for congenital heart diseases. They were 8- and 5-month-old. They were diagnosed as having corrected transposition of the great arteries (TGA) and tetralogy of Fallot respectively, and underwent bidirectional Glenn anastomosis and right modified Blalock Taussig shunt. Chylothorax was revealed on the 11th and the 1st postoperative day, and was not improved by any conventional therapy in either case. Then octreotide acetate was infused continuously with 0.1-0.6 micorg/kg/hour for 24 and 7 days. Chylothorax disappeared completely without any complications such as disturbance of blood sugar level or growth retardation. Octreotide acetate was effective and safe even in infants in intractable chylothorax after surgery for congenital heart diseases, as long as used for short period.
Undifferentiated pleomorphic sarcoma (UPS) is a soft tissue sarcoma, occurring most commonly on the lower extremities. We herein report a rare case of primary UPS adjacent to the ascending colon and in the right iliopsoas muscle. Computed tomography of the abdomen revealed large masses, and the patient experienced a high-grade fever, leukocytosis, elevated serum C-reactive protein level, and hematopoietic activation on 18F-fluorodeoxyglucose-positron emission tomography. This inflammatory reaction was caused by granulocyte colony-stimulating factor secreted by tumor cells. Surgical resection was performed, and the inflammatory reaction disappeared immediately. The patient received adjuvant chemotherapy and survived one year after the operation without evidence of recurrence.
In autosomal dominant polycystic kidney disease (ADPKD), renal cyst lesions predominantly arise from collecting ducts (CDs). However, relevant CD cyst models using human cells are lacking. Although previous reports have generated in vitro renal tubule cyst models from human induced pluripotent stem cells (hiPSCs), therapeutic drug candidates for ADPKD have not been identified. Here, by establishing expansion cultures of hiPSC-derived ureteric bud tip cells, an embryonic precursor that gives rise to CDs, we succeed in advancing the developmental stage of CD organoids and show that all CD organoids derived from PKD1−/− hiPSCs spontaneously develop multiple cysts, clarifying the initiation mechanisms of cystogenesis. Moreover, we identify retinoic acid receptor (RAR) agonists as candidate drugs that suppress in vitro cystogenesis and confirm the therapeutic effects on an ADPKD mouse model in vivo. Therefore, our in vitro CD cyst model contributes to understanding disease mechanisms and drug discovery for ADPKD.
Reaction-Time Assessment of Beliefs Underlying the Irrational Ratio-Bias in Choice. Kimihiko YAMAGISHI Yu NISHIMURA (kimihiko@ky.hum.titech.ac.jp) (yunishi@ky.hum.titech.ac.jp) Graduate School of Decision Science & Technology Tokyo Institute of Technology, Box W9-21 Ohokayama 2-12-1, Meguro-Ku, Tokyo 152-8552, JAPAN Abstract People often judge uncertainty expressions by ratios composed of greater numbers (e.g., 100 out of 5,000) as more probable than consisting of smaller ones (e.g., 1 out of 50). Literature refers to this well-replicated phenomenon as the ratio-bias. We investigated an irrational choice reflecting the ratio-bias, wherein decision makers preferred a 9/100 chance of winning a gamble over 1/10. Our analyses went beyond previous account of this irrationality by empirically assessing decision makers' subconscious belief pertaining to this choice situation. We found that decision makers exhibiting such preferences associated the 9/100 chance to benefits more strongly to 1/10. Therefore, they preferred the alternative which they unconsciously evaluated as more lucrative. We shall discuss implications for decision making literature supporting the dichotomy of cognitive systems into quick and irrational and slow, deliberate, and rational. Imagine yourself preparing for a business trip. The Federal Aviation Administration (FAA) has been practicing random screening of passengers at the airport. If this occurred to you, the security personnel would pull you out of line and check you more thoroughly, taking your time. Therefore you had better go to the airport well in advance to departure. How often would it occur? After searching the Internet, you find one webpage describing the possibility as 1 in 250, whereas another page showing 10 in 2,500. Now, which webpage suggests a greater chance of running into this drudgery? The rational answer, of course, is that both sources of information communicate exactly the same degree of uncertainty, namely 0.4%. However, people often perceive the latter representing a greater chance than the former. Literature shows numerous examples of this irrational belief affecting wide variety of judgment and choice, referring to this tendency as ratio-bias. McFarland and Miller (1994) told their participants that s/he ranked at the 30th percentile on a fictitious Social Perceptiveness Ability test. Concretely, the participants were told their rank as either 300th among 1,000 people or 3rd in 10. As the group size increased, pessimistic participants self-rated lower ability levels, whereas optimistic participants reported higher ability. In Miller, Turnbull and McFarland's (1989) vignettes, a child who adored chocolate-chip cookies successfully found such a cookie. Two vignettes differed in that the cookie jar contained chocolate-chip and less attractive oatmeal in the combination of either 1 and 19 or 10 and 190. The participants judged the child who succeeded in picking up 1 chocolate out of 20 as more suspicious of cheating, expressing their belief that a 1 in 20 chance was less likely to actualize than 10 in 200. Moreover, ratio-biases extended to cases of uneven odds. In risk perception, Yamagishi (1997) reported that people rated cancer as more seriously life-threatening when they read that cancer kills 1286 out of 10,000 people in the population than 24.14 out of 100. Perhaps the most straightforward example of irrationality due to the ratio-bias may be found in the experiment of Denes-Raj and Epstein (1994). Denes-Raj and Epstein presented participants with a pairwise choice of gambles. Option 1 offered a 1-out-of-10 chance (10%) of winning $1. Option 2 offered a 9-out-of-100 chance (9%) of winning the same amount. The majority of participants preferred Option 2 despite that Option 1 offered a superior percentage to win. In response to the experimenter's interview for justifications of the choice, the participants admitted the irrationality in their preference. In contrast, when the same participants faced another gamble situation with negative payoffs (i.e., the chance was to lose their money), the majority chose the option offering a smaller chance to lose, thereby performing rationally. The current investigation focuses exclusively on this phenomenon, and we refer to this study as the DRE experiment. We regard the ratio-bias instantiated by the DRE experiment, especially favoring a 9/100 chance to win over 1/10, as a striking example of irrationality for the following reasons. First, the irrationality is self-evident such that a naive person without formal training on rational theories of choice would easily comprehend why such preference is logically indefensible 1 . Second, despite the simplicity in the observed phenomenon per se, influential explanatory theories of decision making such as Prospect Theory (Kahneman & Tversky, 1977) fail to explain the DRE experimental result. Compare the DRE experimental finding to, for example, the oft- cited Allais paradox in decision making literature (Allais, 1953). It requires profound understanding of the normative desiderata of rational choice (e.g., von Neumann and Morgenstern (1944)) to appreciate why preference in the Allais paradox lacks logical coherence.
