Pancreatic Pseudocysts - Proposal for Diagnosis and Surgical Management -

To determine the clinical features and problems presented by a pancreatic pseudocyst, eighteen patients managed at our hospitals since 1980 were reviewed. Males predominated with a ratio of 16: 2, and the average age was 36.2 years. Pseudocyst was located in the pancreatic head in 6, in the body in 6, in the tail in 5 and multiple pseudocysts in one case. The cause of pancreatic pseudocyst was chronic pancreatitis in 9 (including 8 patients with histories of alcoholism), acute pancreatitis in 2 and trauma in 7 patients, respectively. Three patients were associated with pancreatic calculi. Rupture of pseudocyst occurred in one patient with multiple cysts. Autopsy showed acute pancreatic necrosis and penetration to the stomach and duodenum. The indications for surgery were principally cyst-related symptoms(infection, hemorrhage, enlargement and compression of adjacent organs) and differential diagnosis from malignancy. Most of the patients underwent internal drainage ; 9 cystojejunostomy, 2 cystogastrostomy). Three patients underwent cystojejunostomy with longitudinal pancreaticojejunostomy for chronic pancreatitis. Massive hemorrhage after cystogastrostomy occurred in one patient with infected pseudocysts, which required removal of the cysts. Postoperative outcome of the 17 surgical patients was excellent in 16 patients. Only one patient died of pancreatitis associated with alcohol abuse, resulting in a 5.9% mortality. This study suggests that adequate internal drainage by pancreaticojejunostomy to treat the underlying pancreatic disease is most important to obtain an excellent prognosis in patients with pseudocysts

Biliary Cystadenocarcinoma - Report of 2 Cases -

The clinical and pathologic features of two patients with biliary cystadenocarcinoma were presented and the previous literatures were reviewed. Case 1 : A 52-year-old man complained of heart burn and weight loss. Abdominal ultrasound and CT offered suspicions of biliary cystadenocarcinoma of the left hepatic lobe. Left hepatic lobectomy was performed, but the tumor invaded to adjacent viscera. The resected tumor (26×21×5.5 cm) was multilocular cystadenocarcinoma with mucin production. He survived for one year and 8 months after surgery. Case 2: A 60-year-old man suffering from sudden-onset frost and high fever underwent left lateral segmentectomy of the liver with a diagnosis of cystadenocarcinoma defined by biopsy specimen in previous operation. The tumor (6.0×4.5×3.5 cm) was multilocular cyst with mucin-producing papillary adenocarcinoma. He died of recurrent cancer 2 years and one month after surgery. The histogenesis of cystadenocarcinoma is still unclear because of its rare disease. The presence of benign epithelium in our cases may support their origin from cystadenoma

The Japanese Clinical Practice Guideline for acute kidney injury 2016

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search

High-resolution melting analysis for a reliable and two-step scanning of mutations in the tyrosine kinase domain of the chimerical bcr-abl gene.

For relevant imatinib therapy against Philadelphia (Ph)-positive leukemias, it is essential to monitor mutations in the chimerical bcr-abl tyrosine kinase domain (TKD). However, there is no universally acceptable consensus on how to efficiently identify mutations in the target TKD. Recently, high-resolution melting (HRM) technology was developed, which allows gene scanning using an inexpensive generic heteroduplex-detecting dsDNA-binding dye. This study aimed to validate the introduction of HRM in a practical clinical setting for screening of mutations in sporadic sites of the chimerical bcr-abl TKD. All chimerical and wild-type abl TKD regions selectively amplified were used for HRM assays and direct sequencing. The HRM test had approximately 5-90% detection sensitivity for mutations. In contrast to mixture samples with mutant and wild-type cells, all mutant cell samples had indeterminate melting curves equivalent to those of the wild-type due to formation of only a homodulex. This issue was improved by the addition of exogenous wild-type DNA after PCR. Subsequently, HRM results gave a high accordance rate of 97.8% (44/45 samples) compared to the sequencing data. The discordant results in one appear to be due to unsuccessful amplification. Thus, HRM may be considered to be suitable for reliable scanning of mutations in the chimerical abl TKD in a clinical setting

右開胸開腹胸部食道全摘術後に食道裂孔開大部から左胸腔内へ空腸が脱出陥頓した1例

金沢大学医学部附属病院外科学会抄

INTRAVENOUS INFUSION OF FAT EMULSION. EXPERIMENTAL AND CLINICAL STUDIES ON INTRAFAT

Experimental and clinical studies on Intrafat (DI-22), a fat emulsion for intravenous infusion which was recently developed in Japan, were conducted. Intrafat consists of a 10% solution of soya bean oil and as an emulsifier egg yolk phospholipid which is added to stabilize the emulsion, and to make it isotonic a 2.5% glycerol is added. During the past 18 years we studied the many aspects concerning the use of emulsified soya bean oil for tube feeding to be used for the nutritional management of patients undergoing operations. Recently we in Japan have been able to develop such a fat emulsion to be administered intravenously, whereby an equal amount of fat as in tube feeding can be introduced. The side effects of Intrafat were very mild and no sign of overloading syndrome was observed. Intrafat is not only safe for clinical use but valuable for studies of metabolic changes to be made in the future