Basaloid squamous cell carcinoma (BSC) of the esophagus is a rare malignant disease. We report here a patient with recurrent esophageal BSC, who was successfully treated by systemic chemotherapy containing 5-fluorouracil (5-FU) and cisplatin (CDDP). A 57-year-old woman was diagnosed as having squamous cell carcinoma of the esophagus upon endoscopic examination. Curative esophagectomy with lymph node dissection was performed under the thoracoscope. The pathological diagnosis of the surgical specimen was BSC. Five months after operation, the patient was diagnosed as having a recurrence of the BSC with metastases to the liver and spleen, and a right paraclavicular lymph node. She was given systemic chemotherapy consisting of continuous infusion of 800 mg/d of 5-FU and 3 h infusion of 20 mg/d of CDDP for 5 consecutive days every 4 wk. The metastatic lesions in the spleen and right paraclavicular lymph node disappeared, and the liver metastasis was apparently reduced in size after 2 courses of chemotherapy. The tumor regression was seen over 6 courses, with progression afterwards. Although subsequent treatment with CPT-11 and CDDP was not effective, docetaxel and vinorelbine temporarily controlled the tumor growth for 2 mo. 5-FU and CDDP combination may be useful for the patients with advanced BSC.

AimIn recent years, with the concept of damage control resuscitation, hemostasis and preoperative fluid restriction have been carried out, but there is controversy regarding the effectiveness of fluid restriction.MethodsFrom April 2007 to March 2013, 101 trauma patients presented with hemorrhagic shock (systolic blood pressure ≤90 mmHg) at the prehospital or emergency department and were admitted to Hyogo Emergency Medical Center (Hyogo, Japan). They underwent emergency hemostasis by surgery and transcatheter arterial embolization. We compared two groups in a historical cohort study, the aggressive fluid resuscitation (AR) group, which included 59 cases treated in the period April 2007–March 2010, and the fluid restriction (FR) group, which included 42 cases treated in the period April 2010–March 2013.ResultsThere was no difference between both groups in patient background (heart rate, 110 b.p.m.; systolic blood pressure, 70 mmHg). The Injury Severity Score was 34 (AR) versus 38 (FR) (not significant). Preoperative infusion volume of crystalloid significantly decreased, from 2310 mL (AR) to 1025 mL (FR) (P ≤ 0.01). There was no difference in mortality (36% [AR] versus 41% [FR]). Ventilator days significantly decreased, from 8.5 days (AR) to 5.5 days (FR) (P = 0.02).ConclusionsPreoperative fluid restriction for trauma patients with hemorrhagic shock did not improve mortality, but it decreased ventilator days by reducing the perioperative plus water balance and it might contribute to perioperative intensive care.

Follow-up tests after percutaneous coronary intervention (PCI) are considered inappropriate for asymptomatic patients. Despite this perception, many cardiologists conduct follow-up tests as routine practice. The objective of this study was to investigate the survival benefits of follow-up testing after PCI in a real-world setting in Japan. A nationwide Japanese administrative database was used to identify unselected patients who underwent PCI with stent implantation between January 2010 and December 2013. We used time-dependent Cox proportional hazards models to evaluate the association between follow-up testing and outcomes. The primary outcome was the composite of all-cause death and acute myocardial infarction (AMI). Among a total of 21,409 patients, 15,095 (70.5%) completed follow-up testing, of whom 9814 (45.0%) underwent coronary angiography. During a median of 2.7 years of observation, the primary outcome occurred less frequently for patients who underwent follow-up testing (1.21 vs. 4.51% per year; adjusted hazard ratio, 0.59; 95% CI 0.52-0.67; p < 0.001). Individual rates of all-cause death and AMI were also lower for the patients who underwent follow-up testing. Follow-up testing was associated with a lower risk of all-cause death and/or AMI. However, because of the unexpectedly large effect and many limitations of the administrative data, our findings should be further investigated to assess the net benefit of follow-up tests. In addition, we do not intend to encourage routine follow-up tests for patients without clear clinical indications. Follow-up tests should be conducted in accordance with clinical indications.

Mortality due to acute myocardial infarction (AMI) has been declining in past decades [1]. Admission to the intensive care unit (ICU) after developing AMI has been widely accepted as a standard practice and is thought to play a major role in improving outcomes. On the other hand, ICU stays represent a substantial financial burden [2]. In addition, evidence that justifies its use, such as a reduction in mortality, has never been shown in the contemporary revascularization era.No randomized controlled trials have been conducted to investigate the mortality benefit of ICU admission in patients with AMI. There are several observational studies with conflicting results [3][4][5][6][7][8][9][10][11][12]. The clinical guidelines in the USA recommend admission to a coronary care unit under specific conditions for non-ST-elevation acute coronary syndromes, and the use of an ICU is not mentioned for those with ST-elevation myocardial infarction (STEMI) [13,14]. The clinical guidelines of the European Society of Cardiology and the Japanese Circulation Society recommend that patients suffering from AMI be admitted to the ICU [15][16][17][18], although supporting evidence is lacking thus far.Among the major limitations of the previous studies are small sample sizes, a limited number of study sites, or lack of clinically

Aim The global outbreak of coronavirus disease (COVID‐19) has had widespread effects on clinical practice, and is reportedly associated with reduced percutaneous coronary intervention (PCI) rates in the US and Italy. This study aimed to ascertain the influence of the COVID‐19 outbreak on PCI practice in Japan. Methods In a retrospective analysis of claims data from National Health Insurance and Later‐Stage Elderly Healthcare System enrollees in Kobe City, Japan, we examined the changes in PCI incidence before and during the COVID‐19 outbreak. Percutaneous coronary intervention incidence during the COVID‐19 outbreak in 2020 was compared with that of the same (pre‐outbreak) period in 2019 using a Poisson regression analysis with the monthly number of PCIs as the dependent variable. Results A total of 639 patients underwent PCI in Kobe City between February and May 2020. The results showed a 19% reduction in all PCI procedures during the outbreak relative to the pre‐outbreak period (P = 0.001). There were no significant changes in non‐elective PCIs for acute coronary syndrome (ACS) cases, but a 25% reduction in elective PCIs for non‐ACS cases ( P < 0.001). Conclusions The COVID‐19 outbreak was associated with a decline in elective PCIs for non‐ACS cases, but did not appear to influence non‐elective PCIs for ACS cases in Japan.