BackgroundAxillary reverse mapping (ARM) is a novel technique for preserving the upper extremity lymphatic pathways during axillary lymph node surgery. However, there is no evidence of the usefulness of ARM for patients undergoing sentinel lymph node biopsy (SNB).MethodsBetween August 2009 and July 2012, 372 patients who underwent the SNB procedure for breast cancer were enrolled in this study. Using the indocyanine green fluorescence technique and indigocarmine blue dye method, we studied the relationship between the upper extremity lymphatic flow and breast sentinel node (SN). Our aim of this study was the probability of postoperative lymphedema with respect to whether the upper extremity lymphatics corresponded to the breast SN.ResultsAmong the 327 patients who underwent the SNB procedure, the upper extremity lymphatics drainage into the breast SN in 76 (23.2%; corresponding group), and only 5 patients in this group developed lymphedema. In contrast, none of the patients in the noncorresponding group developed lymphedema.ConclusionsARM during SN biopsy can identify the group of patients who are at high risk for developing lymphedema. More risk-focused guidance should be used for these patients. J. Surg. Oncol. 2014 109:612–615.

Our results indicate sitagliptin is effective and safe for the treatment of T2DM complicated with NAFLD.

Objective The aim of this retrospective cohort study was to assess the predictive factors for the regression from impaired glucose tolerance (IGT) to normal glucose regulation (NGR) in patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 164 NAFLD patients who had IGT in the first 75-g oral glucose tolerance test (OGTT) and underwent a repeated OGTT five years later were enrolled. A multivariate logistic regression analysis was carried out to identify factors predicting the regression from IGT to NGR. Results Out of the 164 patients, 29 regressed from IGT to NGR within five years after the first OGTT. The multivariate analysis by logistic regression showed that regression from IGT to NGR occurred when the patient was young (risk ratio for ten years: 0.38; 95% confidence interval [CI] 0.20-0.72; p=0.003), had a fasting plasma glucose (FPG) level of <100 mg/dL (risk ratio: 6.53; 95%CI 1.88-21.73; p=0.003), had a 2-hr post-load plasma glucose (PG) level of <160 mg/dL (risk ratio: 4.86; 95%CI 1.08-22.72; p=0.040), a body mass index (BMI) decrease of ! 1.5 (risk ratio: 5.20; 95%CI 1.41-19.24; p=0.014), physical activity of ! 2 Metabolic Equivalent of Task (MET) h/day (risk ratio: 5.57; 95%CI 1.68-18.44; p=0.005), and showed disappearance of the fatty liver by ultrasonography at five years (risk ratio: 9.92; 95%CI 2.87-34.34; p<0.001). Conclusion Our results suggest that six factors: young age, FPG <100 mg/dL, 2-hr post-load PG of <160 mg/dL, BMI decrease of ! 1.5, physical activity of ! 2 MET h/day, and the disappearance of fatty liver predict the regression from IGT to NGR in NAFLD patients.

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We describe a case with main portal vein tumor thrombosis and splenic metastases from a gastric cancer. This is the first clinical report of these two metastases occurring concomitantly. The patient had no liver metastasis prior to therapy. We judged the tumor in this case to be unresectable and injected OK‐432 directly into the primary gastric cancer. Injection of OK‐432 resulted in remarkable reductions, in the sizes of the metastatic lesions in the spleen and some reduction in the size of the primary tumor. Moreover, the patient survived for 1 year and 7 months, commuting 544 km monthly by train for 1 year and 4 months to undergo treatment. The course of this patient suggests that the main effect was local immune activation, rather than an increase in systemic nonspecific immune functions. In addition, this therapy was very useful for maintaining the quality of life of this patient.