Spin-1/2 Triangular-Lattice Heisenberg Antiferromagnet with √3 × √3-Type Distortion --Behavior around the Boundaries of the Intermediate Phase

The S = 1/2 triangular-lattice Heisenberg antiferromagnet with distortion is investigated by the numerical-diagonalization method. The examined distortion type is √3 × √3. We study the case when the distortion connects the undistorted triangular lattice and the dice lattice. For the intermediate phase reported previously in this system, we obtain results of the boundaries of the intermediate phase for a larger system than those in the previous report and examine the system size dependence of the boundaries in detail. We also report the specific heat of this system, which shows a marked peak structure related to the appearance of the intermediate state

Gross E esophageal atresia with unique course

The patient was a 15 months-old boy who had been diagnosed CHARGE syndrome, which is a multiple congenital anomaly syndrome caused by mutations in the CHD7 gene. Mechanical ventilation management was initiated 2 hours after birth for dysphagia and respiratory failure, and tracheotomy was performed 3 months after birth for dysphagia and failed extubation. He was repeatedly hospitalized due to pneuomoniae. Approximately 1 year after birth, the boy had two consecutive episodes of sudden ventilatory insufficiency while replacing the tracheotomy cannula. A bronchoscopic examination under general anesthesia revealed a tracheoesophageal fistula directly below the tracheostomy. The patient was diagnosed with Gross E esophageal atresia, and we speculated that the cannula migrated to the esophagus via the fistula during tracheostomy cannula replacement. Gross E esophageal atresia is a rare disease. Its diagnosis is often delayed, and it is discovered by recurrent pneumonia in many cases. A tracheoesophageal fistula may also be found in children with deformities of the respiratory system. Furthermore, tracheoesophageal fistulae are often found in the neck. Therefore, when sudden ventilatory insufficiency occurs in a child with a tracheostomy after replacing the tracheostomy cannula, caution must be exercised since the cannula may have migrated to the esophagus via a fistula

イ ショクドウ ギャクリュウショウ ニ タイスル フククウキョウカ Nissen フンモン ケイセイジュツ ニオケル ショクドウ チョクセツ コテイ ノ ジュウヨウセイ ニ カンスル ケントウ

【Background】 For the neurologically impaired（NI）patients with gastro-esophageal reflux disease（GERD） who underwent laparoscopic Nissen fundoplication, the direct suture between the esophagus and diaphragmatic crus（esophagus direct suture）was changed from one to three stiches in order to prevent the postoperative recurrence due to wrap herniation. Therefore, the postoperative outcome was evaluated before and after this change retrospectively. 【Methods】 Seventy-two NI patients（ ５３ boys and １９ girls, mean age９１. years old）with GERD performed laparoscopic Nissen fundoplication from ２００５ to ２０１２ were enrolled in this study. Surgical procedure was laparoscopic Nissen fundoplication for all patients and additional gastrostomy at the same time for６８cases（９４％）. Patients were divided into the following two groups : early period group（n＝２７）and late period group（n＝４５）. The early period group included the number of esophagus direct suture was one stitch from２００５to２００７and the late period group included the number of esophagus direct suture was three stitches from２００８to２０１２． 【Results】 There was no intraoperative complication in both two groups. In postoperative complication rate, there was no significant difference between the two groups though one case（２．２％）showed a gastric perforation in the late period group. Postoperative recurrence was found ９ cases （１２．５％）due to wrap herniation. In postoperative recurrence rate, the early period group was ２２．２％（n＝６）and the late period group was ６．７％（n＝３）. The modified esophagus direct suture by from one stitch to three stitches had a tendency to decrease the postoperative recurrence rate（p＝０．０５）. For nine recurrent cases, re‐operation was performed in two patients, esophagogastric dissociation in one patients and observation in six patients. 【Conclusions】 Devising the esophagus direct suture in the laparoscopic Nissen fundoplication for NI patients might have the possibility to prevent the recurrence due to wrap herniation

Treatment strategy for successful hepatic resection of icteric liver

Background : The treatment strategy for jaundiced patients with hilar cholangiocarcinoma (HC) is not well established. In this study, we evaluate the feasibility of our perioperative protocol for jaundiced patients with HC. Methods : Twenty patients with HC who underwent hepatic resection at our institute were enrolled, and patients were divided into icteric(n=6) and normal(n=14) group. As a perioperative protocol, Oral administration of Inchinkoto(ICKT), steroid and nafamostat mesilate were introduced. The evaluation of functional future remnant liver(FRL) by asiaroscintigraphy, and postoperative outcomes were retrospectively compared. Results : Indocyanine green dye retention rate at 15 minutes was higher, and LHL15 values was lower in icteric group. However, in the functional evaluation of FRL, which was the sum of GSA uptake of the future FRL, there was no significant difference of LHL15 values of the remnant liver functional reserve between the two groups. As results, according to the difference of liver function, serum AST level was not different between two groups. The number of patients with postoperative morbidity in the two groups was comparable. Conclusions : Even in HC patients with icteric liver, accurate assessment of liver functional reserve and effective perioperative treatment may attribute to successful hepatectomy and favorable post-operative outcomes

インフラマソーム活性化に注目した膵・胆管合流異常の発癌における特徴的な粘膜下変化

Background This study investigated submucosal alterations in biliary carcinogenesis of pancreaticobiliary maljunction (PBM). Methods Thirty-three patients with PBM (including seven with gallbladder [GB] cancer), four with neither biliary tract cancer nor PBM who underwent pancreaticoduodenectomy (controls), and seven with chronic cholecystitis without PBM were enrolled. Protein expression of α-smooth muscle actin (αSMA), CD68, and CD204 in the GB lamina propria and that of NLRP3 and caspase 1 in the GB epithelium and lamina propria were examined. Results Compared with the control and cholecystitis groups, αSMA expression was higher in the cancerous part (stroma) of the GB in patients with GB cancer + PBM and in the lamina propria of patients with PBM. The CD204/CD68 ratio in the lamina propria was higher in the PBM group than in the control and cholecystitis groups. NLRP3 and caspase 1 expression in both the lamina propria and epithelium was higher in the PBM than control group. In the PBM group, NLRP3- and caspase 1-positive cells in the lamina propria were located near the epithelium. Conclusion Activated fibroblasts and M2 macrophages in the GB lamina propria may be associated with biliary carcinogenesis of PBM, possibly through inflammasome activation

Indigo Carmine Dye-Assisted Lymphatic-Sparing Laparoscopic Palomo Varicocelectomy In Children

The ideal method for varicocelectomy in children remains controversial. We present our experience with dye-assisted lymphatic-sparing laparoscopic varicocelectomy (LSLV) in children, which overcomes the limitations of previously described techniques. Materials and methods : Five consecutive LSLVs were performed over a period of three years on children with a mean age of twelve years. The varicocele grade was three in one case and grade 2 in four cases, respectively. A left subdartos injection of 2 ml of Indigo carmine dye was done using a 25-gauge needle at ten minutes before an operation. A scrotal injection of lymphatic dye was utilized to spare at least one lymphatic and the remaining spermatic vessels were divided. Results : Lymphatic-sparing was accomplished in all cases. No peri-operative complication was noted.We spared one lymphatic channel in one patient (20%) and two channels in four patients (80%). There were no cases of hydrocele or residual varicocele. Conclusion : Dye-assisted LSLV is easily accomplished with an excellent surgical outcome and sparing one or two lymphatics appears to be sufficient to avoid secondary hydrocele

ワカテ ショウニ ゲカイ ノ ECFMG certificate シュトク エノ チョウセン : ベイコク ショウニ ゲカ リンショウ リュウガク オ メザシテ

Recently, many Japanese pediatric surgeons undertake clinical training abroad, especially in the United States of America (USA) which is one of the most attractive country for advanced clinical training. Since the Japanese government introduced a 2-year mandatory residency program in 2004, it has become more and more important for busy Japanese residents to spent time efficiently in order to achieve ECFMG (Educational Commission For Foreign Medical Graduates) certification. ECFMG certification requires residents to pass both Step 1 and 2 of the United States Medical License Examination (USMLE). It is especially difficult to pass step2 CS (Clinical Skills) for many Japanese who are unfamiliar with the English language. For example, one of authors started to study for the USMLE in the 6th grade of the Japanese Medical School (MS4), passed step1 and step2 CK (Clinical Knowledge) during the 2-year mandatory intensive rotating residency program, and passed Step2 CS on the 3rd attempt during the general surgery residency program. This shows that a Japanese examinee can pass the ECFMG certificate even during a busy rotating residency program

Pancreatectomy in patients with HD

Background : Several reports have shown the high mortality rate of pancreatic resection in patients with hemodialysis (HD), however, its long-term outcome remains unclear. In this study, we examined cases of pancreatic resection in patients with HD and conducted a literature review. Methods : Four patients with HD who underwent pancreatic resection from 2004 to 2019 were enrolled. To compare the clinicopathological variables of HD and non-HD patients, 161 non-HD patients who had undergone surgical resection for pancreatic cancer were enrolled. Results : Among four cases of pancreatic resection with HD, three cases were malignant diseases. All patients with HD had some co-morbidities (100% in HD group, 45.3% in the non-HD group) and postoperative complications (100% in the HD group, vs 46.6% in the non-HD group). Although one patient had severe postoperative complications and length of postoperative hospital stay was longer, the 30- and 90-day mortality rates were both 0% in patients with HD. However, three cases in the HD group (75%) died approximately 6 months after surgery, including one cancer-related death. Conclusions : Pancreatic surgery in patients with HD should be carefully indicated, especially pancreaticoduodenectomy or total pancreatectomy, because of the poor prognosis induced by non-cancer-related causes of death

Torsion of an accessory spleen with situs inversus in a child

We present an unusual case of acute abdomen caused by torsion of an accessory spleen with situs inversus in a child. A three-year-old girl was admitted to our hospital with an 11-day history of right flank pain with fever. Her medical history revealed an operation of coarctation of the aorta with situs inversus at one month of age. Physical examination revealed a right flank mass and tenderness. A contrast-enhanced CT scan showed a normally enhanced small spleen in the right upper quadrant and a 7.0×6.0×3.5 cm, hypodense, marginal enhancing mass in　the right midabdomen adjacent to　the intestine. An emergency laparotomy was　decided upon with a preoperative diagnosis as an acute abdomen. During surgery, a mass was found under the greater omentum and two accessory spleens of 1.5 cm in diameter were found surrounding the main spleen. Several loops of bowel were adherent to the mass. The loops of bowel were dissected away. A pediculated congested mass was observed as an accessory spleen emerging from the greater omentum. The mass was twisted on its vascular pedicle and strangulated. The necrotic mass was removed and the postoperative recovery was uneventful. Though torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in childhood

フクブ ショクドウ チョウフクショウ ニ タイシ フククウキョウカ テキシュツジュツ オ シコウ シタ １レイ

A 9-year-old boy was admitted to the hospital for close exploration of cystic tumor of the esophagus ventral detected in the abdominal contrast CT scan during the investigation of hematuria. Upper gastrointestinal fluoroscopic and endoscopic examination with ultrasonography showed a cystic tumor with the diameter of 2cm and smooth surface in the abdominal esophagus. Laparoscopic surgery was performed under the diagnosis of abdominal esophageal duplication cyst. At surgery, the soft and well-defined mass was present in the abdominal esophagus ventral and continuous with the esophagus wall. Histopathological study showed the cystic wall was lined with the pseudostratified ciliated epithelium and subepithelial muscle layer. These findings indicated abdominal esophageal duplication cyst. He was discharged on postoperative day 8 with good postoperative course. Abdominal esophageal duplication cyst is a rare disease. Laparoscopic surgery, which has not seen attempted before this case, seems to be a useful treatment of abdominal esophageal duplication cyst