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Background I Purpose. Most patients with hepatocellular carcinoma in Japan also have liver cirrhosis. Therefore, reliable information about liver function is essential before undertaking liver resection. Occasionally preoperative estimates and intraoperative findings are disparate. This study used rats with liver fibrosis and a new tactile sensor to determine whether quantification of liver hardness intraoperatively can be used to validate the preoperative assessment of liver function prior to hepatectomy. Methods. Liver fibrosis was induced by administration of thioacetamide to rats. Laparotomy was performed. In some rats, blood samples were taken for examination, and liver stiffness and tactile values were measured by a new tactile sensor. A biopsy specimen from each removed liver was taken, and the hepatic fibrosis index was measured by computed color image analysis after Azan blue staining. The other rats underwent partial hepatectomy, and the bromodeoxyuridine labeling index was calculated in them. Correlations between stiffness, tactile values, and other data were calculated. Results. A strong correlation existed between stiffness and both the hepatic fibrosis index and the bromodeoxyuridine labeling index, and between tactile values and both the hepatic fibrosis index and the bromodeoxyuridine labeling index. Conclusions. Liver hardness proved to be a function of hepatic fibrosis. The tactile sensor proved to be an easy and reliable way to evaluate the hepatic fibrosis index. Quantification of liver hardness by tactile sensor predicted liver regenerative activity.

Key Clinical MessageEnlarged eccrine porocarcinoma of the knee was encountered as a hemorrhagic bulky tumor. After controlling bleeding with Mohs’ paste, local excision of the lesion was the mainstay of treatment. Pathological examination revealed poroid cells, cuticle cells, and prickle cells cancer components, suggesting that malignancy must be excluded by resection.

BackgroundPoland syndrome is a congenital malformation characterized by ipsilateral hand and chest wall depression, including an absence or hypoplasia of the breast and pectoral muscles. These hypoplastic defects are reportedly caused by a subclavian artery supply disruption sequence.Case presentationA 45-year-old Japanese woman, an out-patient, underwent an emergency examination for intense left lower abdominal pain. Computed tomography images revealed a hydronephrotic left kidney and dilatation of the left ureter. No ureteral calculus or neoplasm was found. In addition, no abnormalities connected to her left abdominal pain were found. Nephritis was diagnosed based on the results of urine analysis, and a course of antibiotics was administered. Computed tomography images also revealed a history of breast reconstruction with a custom-made silicone implant in her right breast. The present case showed symptoms of Poland syndrome, which were absence of the sternal head of the right pectoralis major and asymmetrical malformation of the chest wall due to hypoplasia of the right rib cage. In addition to typical Poland syndrome symptoms, she had hypoplasia of her right kidney, hypoplasia of the right gluteus minimus muscle, right-sided pelvic hypoplasia, spinal curvature to the right, and a cystic mass in her right ovary.ConclusionsIn the present case of Poland syndrome, computed tomography images revealed malformation of the chest wall, absence of the pectoral muscle, and hypoplasia of a left kidney. Unilateral visceral hypoplasia is reported to be caused by a subclavian artery supply disruption sequence that occurs around 7 to 8 weeks of gestation. The present case can be considered a rare atypical phenotype of Poland syndrome with possible subclavian artery supply disruption sequence with internal iliac artery supply disruption.

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