Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Feasibility and problem in managements of the patients with acute cholecystitis: A historical study at a single province institute.

Objectives: "Practice Guidelines for Acute Cholecystitis and Acute Cholangitis (in Japanese)," issued in 2005 in Japan, recommends early cholecystectomy in patients with acute cholecystitis. We evaluated the feasibility and problems in management of this condition. Method: We analyzed the clinical and laboratory data of 120 consecutive patients in whom cholecystectomy was performed for treatment of acute cholecystitis between April 2003 and March 2010 in our hospital. Results: After the Guidelines were issued, the rate of urgent operations increased (from 2.4% to 35.4%; p < 0.001) and the length of preoperative hospital stay decreased (form 12.5 days to 7.6 days; p < 0.05). Urgent operation, however, was chosen in only 35.4% of the patients even after the Guidelines were issued, mainly because of the shortage of surgeons and anesthesiologists. In these patients with moderate to severe acute cholecystitis, percutaneous cholecystostomy (PC) was performed without severe complications, followed by cholecystectomy. Conclusion: Urgent operation for acute cholecystitis has the advantages of earlier alleviation of symptoms and shorter hospital stays than PC followed by surgery or elective operation. PC followed by surgery may be a suboptimal option for patients with moderate to severe acute cholecystitis who might be able to tolerate an urgent operation, given that appropriate human resources are not available

Cutaneous T-cell-attracting chemokine as a novel biomarker for predicting prognosis of idiopathic pulmonary fibrosis: a prospective observational study

[Background] Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disease that leads to respiratory failure and death. Although there is a greater understanding of the etiology of this disease, accurately predicting the disease course in individual patients is still not possible. This study aimed to evaluate serum cytokines/chemokines as potential biomarkers that can predict outcomes in IPF patients. [Methods] A multi-institutional prospective two-stage discovery and validation design using two independent cohorts was adopted. For the discovery analysis, serum samples from 100 IPF patients and 32 healthy controls were examined using an unbiased, multiplex immunoassay of 48 cytokines/chemokines. The serum cytokine/chemokine values were compared between IPF patients and controls; the association between multiplex measurements and survival time was evaluated in IPF patients. In the validation analysis, the cytokines/chemokines identified in the discovery analysis were examined in serum samples from another 81 IPF patients to verify the ability of these cytokines/chemokines to predict survival. Immunohistochemical assessment of IPF-derived lung samples was also performed to determine where this novel biomarker is expressed. [Results] In the discovery cohort, 18 cytokines/chemokines were significantly elevated in sera from IPF patients compared with those from controls. Interleukin-1 receptor alpha (IL-1Rα), interleukin-8 (IL-8), macrophage inflammatory protein 1 alpha (MIP-1α), and cutaneous T-cell-attracting chemokine (CTACK) were associated with survival: IL-1Rα, hazard ratio (HR) = 1.04 per 10 units, 95% confidence interval (95% CI) 1.01–1.07; IL-8, HR = 1.04, 95% CI 1.01–1.08; MIP-1α, HR = 1.19, 95% CI 1.00–1.36; and CTACK, HR = 1.12 per 100 units, 95% CI 1.02–1.21. A replication analysis was performed only for CTACK because others were previously reported to be potential biomarkers of interstitial lung diseases. In the validation cohort, CTACK was associated with survival: HR = 1.14 per 100 units, 95% CI 1.01–1.28. Immunohistochemistry revealed the expression of CTACK and CC chemokine receptor 10 (a ligand of CTACK) in airway and type II alveolar epithelial cells of IPF patients but not in those of controls. [Conclusions] CTACK is a novel prognostic biomarker of IPF

Nationwide retrospective observational study of idiopathic dendriform pulmonary ossification : clinical features with a progressive phenotype

Background: Diffuse pulmonary ossification is a specific lung condition that is accompanied by underlying diseases. However, idiopathic dendriform pulmonary ossification (IDPO) is extremely rare, and the clinical features remain unclear. In this study, we aimed to report the clinical characteristics of IDPO. Methods: We conducted a nationwide survey of patients with IDPO from 2017 to 2019 in Japan and evaluated the clinical, radiological, and histopathological findings of patients diagnosed with IDPO. Results: Twenty-two cases of IDPO were identified. Most subjects (82%) were male, aged 22-56 years (mean (SD), 37.9 (9.1)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed.)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed. )) at diagnosis. Nearly 80% of the subjects wereasymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed. Conclusions: IDPO develops at a young age with gradually progressive phenotype. Further research and long-term (>20 years) follow-up are required to clarify the pathogenesis and clinical findings in IDPO

Interleukin-17 receptor antagonist reduces inflammatory response in experimental periodontitis

Aim or Purpose: Interleukin (IL)-17 is one of the inflammatory cytokines caused periodontitis and psoriasis. Psoriasis, a chronic inflammatory skin disease, treats with IL-17 receptor antagonist (brodalumab: BRD). However, little is known about the effect of BRD on periodontitis. This study was evaluated the inhibitory effect of BRD on experimental periodontitis. In addition, we determined the bacterial growth inhibitory effect against Porphyromonas gingivalis (Pg) and inhibitory effect of inflammatory cytokine production in vitro. Materials and Methods: Three-week-old, male, BALB/c mice were orally infected with Pg. BRD was intraperitoneally administered every two days. Fifteen days after the starting of BRD administration, alveolar bone resorption of maxillary samples was evaluated by the distance between cemento-enamel junction and alveolar bone crest, and histopathological examination. To determine the influence of BRD on Pg growth, Pg was inoculated into the bacterial broth containing its antagonist and evaluated the adenosine triphosphate (ATP) activity using a luminometer. The inhibitory effect of inflammatory cytokine production by BRD were analyzed by quantitative polymerase chain reaction. The experimental procedures of this study were approved by the Committee of Ethics on Animal Experiments of Kanagawa Dental University. Results: The volume of alveolar bone resorption was decreased in a concentration-dependent manner. The number of neutrophils and osteoclasts decreased by its administration. The volume of ATP in bacterial broth containing BRD showed a quarter of Pg only cultivation. BRD also reduced the levels of gene expressions on IL-1β, IL-6 and IL-17. These results showed that BRD caused healing of bone and suppressed inflammatory response. Conclusions: Our findings suggest that BRD promotes the prevention of periodontiti

Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Perforated Ileal Diverticulum: Report of a Case

An 80-year-old male was admitted to our hospital on February 16, 2009, complaining of having suffered right lower quadrant pain for a period of 4 days. Abdominal computed tomography (CT) showed amesenterial abscess adjacent to the terminal ileum, and the possibility of acute appendicitis was excluded from the preoperative diagnosis by this imaging. Upon surgery, the appendix and cecum revealed normal appearance, without the presence of ascites. However, ileocecal resectionwas performed because of abscess formation that appeared to originate from the terminal ileum or the cecum. Resected specimens showed ileal diverticula, including one that was perforated. Perforation of ileal diverticula should be a candidate for the differential diagnosis of an inflammatory process near the ileocecal region