Evaluation of Preoperative Magnetic Resonance Cholangiopancreatography in Acute Cholecystitis to Predict Technical Difficulties in Laparoscopic Cholecystectomy

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging technique that provides high-quality visualization of the biliary tree, including the gallbladder. This study aimed to evaluate the useful-ness of preoperative MRCP for acute cholecystitis in predicting technical difficulties during laparoscopic chole-cystectomy (LC). A total of 168 patients who underwent LC with preoperative MRCP were enrolled in this study. Patients were divided into two groups according to preoperative MRCP findings: the visualized group (n = 126), in which the entire gallbladder could be visualized; and the non-visualized group (n = 42), in which the entire gallbladder could not be visualized. The perioperative characteristics and postoperative complica-tions of the two groups were retrospectively analyzed. Operation time was longer in the non-visualized group (median 101.5 vs. 143.5 min; p < 0.001). The non-visualized group had significantly more intraoperative blood loss than the visualized group (median 5 vs. 10 g; p = 0.05). The rate of conversion to open cholecystectomy was significantly higher in the non-visualized group (1.6 vs. 9.5%; p = 0.03). In conclusion, patients in the non- visualized group showed higher difficulty in performance of LC. Our MRCP-based classification is a simple and effective means of predicting difficulties in performing LC for acute cholecystitis

Synchronous Total Occlusion of the Celiac Axis and Superior Mesenteric Artery: An Autopsy Case

Acute mesenteric ischemia (AMI) is often caused by superior mesenteric artery (SMA) embolization. We report a rare case of synchronous celiac axis and SMA embolization in an elderly woman with initially mild abdominal pain. Ultimately, a second contrast-enhanced computed tomography revealed extensive necrosis from the stomach to the transverse colon together with liver ischemia due to hours of occlusion. Multiorgan failure made palliation the only option, and she died the following evening. Autopsy revealed a fragile atherosclerosis-asso-ciated thrombus. Careful examination and repeat diagnostic tests should be performed in patients with mild abdominal symptoms at risk for AMI

Results of elective laparoscopic cholecystectomy for acute cholecystitis following percutaneous transhepatic gallbladder drainage

The Tokyo Guidelines 2013 (TG13) provides a simple criteria and management strategy for acute cholecystitis. The optimal interval between performing percutaneous transhepatic gallbladder drainage (PTGBD) and delayed elective laparoscopic cholecystectomey (LC) and the suitable period of PTGBD, is controversial. In this study, we evaluate the operative outcome of elective LC with PTGBD for the management of acute cholecystitis. We analyzed 21 patients who underwent elective LC following PTGBD. The diagnosis and severity grading for acute cholecystitis was based on TG13. All patients showed grade II/III acute cholecystitis by TG13. Median time interval from onset of acute cholecystitis to PTGBD was 1.5 days (range 0-6). In all patients, local inflammation of gallbladder was improved by PTGBD. Median time interval from PTGBD to elective LC was 46 days (range 12-74). Only one patient (5%) showed bile leakage, and median postoperative hospital stay was 5 days (range 4-15). In conclusion, delayed elective LC following emergent PTGBD is a safe and effective treatment strategy for patients withcomplicated acute cholecystitis

Accuracy of thyroid cancer diagnosis and surgery in patients with thyroid cancer may be affected by the Semipalatinsk Nuclear Test Site: A collaboration between Nagasaki (Japan) and Semipalatinsk (Kazakhstan) medical centers

Background: From 1949 to 1989, 456 nuclear tests were conducted at the Semipalatinsk Nuclear Test Site (SNTS). Exposure was primarily from the first test in August 1949, an atomic bomb test in 1951, and a thermonuclear bomb test in 1953 that affected the Semipalatinsk region. Surgical procedures for patients with thyroid cancer in Semipalatinsk remain unclear. Assessing the clinical behavior of thyroid cancer in patients affected by the SNTS is crucial for confirming an accurate diagnosis and establishing standardized surgery. The first author has been collaborating with the Semey Oncology Center since 1999 to establish an optimal method to diagnose and perform thyroidectomy and lymph node dissection.Objective: To assess the change in the diagnostic accuracy and thyroid surgery from 1999 to 2008 at Semey Oncology Center in collaboration with the Nagasaki University and Nagasaki Medical Center.Materials and Methods: In this cross-sectional study, 169 patients with thyroid cancer who underwent thyroid surgery at the Semey Oncology Center from 1999 to 2008 were evaluated; 125 patients with papillary thyroid cancer were assessed.Results: Before 2001, there were few preoperatively diagnosed thyroid cancer cases; since 2002, the number of preoperatively diagnosed papillary cancer cases increased. From 1999 to 2001, thyroid surgery, including cervical lymph node dissection, was not performed. Partial lobectomy was mainly performed until 2001. Since 2002, total lobectomy was most commonly performed; total thyroidectomy and lymph node dissection were rarely performed.Conclusion: The optimal method for diagnosing thyroid cancer was performed, and an accurate diagnosis changed the surgical procedure

A Case of Asymptomatic Left Ventricular Dysfunction during the Treatment of Metastatic Breast Cancer with Trastuzumab

We report a case of 29-year-old Japanese female with a history of resection of primary carcinoma of the right breast. After a partial response by chemotherapy with pirarubicin and docetaxel for lung metastasis, the patient developed multiple brain and bone metastases. As the degree of overexpression of human epidermal growth factor receptor-2 (HER2) was (2+), trastuzumab was administered in combination with paclitaxel. Asymptomatic left ventricular (LV) systolic dysfunction evaluated by echocardiography was observed ten weeks after the beginning of the treatment. After two weeks of discontinuation of the therapy, however, LV function showed rapid recovery and the resumed use of trastuzumab did not cause further cardiac deterioration. The patient died of sudden respiratory failure due to cerebral herniation and not to heart failure

Cyclooxygenase-2 is Involved in the Progression of Thyroid Cancer

Although the inducible form of cyclooxygenase (COX), COX-2, is highly expressed in various cancers and it is also involved in cancer progression, its role in thyroid cancer is not fully understood. We assessed in the situ cyclooxygenase expression in normal thyroids (n=6), Graves\u27 thyroids (n=6), thyroid adenomas (n=12), thyroid follicular (n=15) and papillary carcinomas (n=30). In comparison to the constitutive expression of COX-1, COX-2 was highly expressed in thyroid cancers (90.0% of thyroid papillary carcinomas and 73.3% of thyroid follicular carcinomas) and moderately in thyroid adenomas (25.5%), but barely expressed in normal and Graves\u27 thyroid tissues. This quantitative assessment employed immunohistochemical methods. Thereafter we compared the effect of COX-2 inhibition on a human follicular thyroid carcinoma cell line (WRO), and a human papillary carcinoma cell line (NPA), using selective COX-2 inhibitor(NS-398). The treatment with 50 μM NS-398 suppressed the growth of the COX-2 expressing cells, NPA cells (37.7%;p<0.01) and WRO cells (10.1%;p<0.05). Moreover, at concentrations ? 100 μM, NS-398 induced cell death a mitochondrial dysfunction. In addition, 50 μM of NS-398 inhibited the activation of extracellular signal-regulated kinase in NPA cells after the stimulation with fetal bovine serum. Our results indicate that COX-2 is involved in the progression of thyroid cancer

Results of laparoscopic subtotal cholecystectomy by laparoscopic linear stapler in difficult cases with severe cholecystitis

Laparoscopic subtotal cholecystectomy (LSC) has been recognized as a safe and feasible alternative surgical procedure for a difficult laparoscopic cholecystectomy (LC) with severe inflammation in Calot’s triangle. We compared the surgical outcomesof cholecystectomy for acute cholecystitis between standard LC and LSC using laparoscopic linear stapler. 172 patients were diagnosed as acute cholecystitis, among them, 16 patients who underwent LSC and other 156 patients who underwent standardLC were enrolled in this study. The severity grading of acute cholecystitis in LSC group was significantly higher than LC group. Operation time was longer in the LSC group than LC group. LSC had significantly more intraoperative blood loss compared to LC. However, there was no significant difference in the postoperative complications between two groups. LSC using laparoscopic linear stapler contributes surgeons avoid common bile duct injury in difficult LC

Direct cell–cell contact between mature osteoblasts and osteoclasts dynamically controls their functions in vivo

Bone homeostasis is regulated by communication between bone-forming mature osteoblasts (mOBs) and bone-resorptive mature osteoclasts (mOCs). However, the spatial–temporal relationship and mode of interaction in vivo remain elusive. Here we show, by using an intravital imaging technique, that mOB and mOC functions are regulated via direct cell–cell contact between these cell types. The mOBs and mOCs mainly occupy discrete territories in the steady state, although direct cell–cell contact is detected in spatiotemporally limited areas. In addition, a pH-sensing fluorescence probe reveals that mOCs secrete protons for bone resorption when they are not in contact with mOBs, whereas mOCs contacting mOBs are non-resorptive, suggesting that mOBs can inhibit bone resorption by direct contact. Intermittent administration of parathyroid hormone causes bone anabolic effects, which lead to a mixed distribution of mOBs and mOCs, and increase cell–cell contact. This study reveals spatiotemporal intercellular interactions between mOBs and mOCs affecting bone homeostasis in vivo

A case of surgical resection for well-differentiated squamous cell carcinoma arising in a ciliated hepatic foregut cyst

Ciliated hepatic foregut cysts (CHFC) are extremely rare, and most are benign cysts of the liver arising from remnants of the embryonic foregut. CHFC is usually found incidentally and as mostly asymptomatic cysts. We report squamous cell carcinoma (SCC) arising in a CHFC in a 50-year-old Japanese woman. She consulted our hospital for upper abdominal pain.A computed tomography and an ultrasound showed a cystic region including calcification and a solid mass in segment 4 of the liver. Left hepatectomy, B6 bile duct resection, and biliary-jejunal anastomosis were performed. Microscopic examination revealed that part of the cyst was lined by a characteristic ciliated pseudostratified columnar epithelium surrounding a connective tissue, a slightly thick fibrotic smooth muscle stromal layer, and an outer fibrous capsule. The cyst wall contained a low-papillary mural nodule showing atypical squamous hyperplasia with high-grade dysplasia. Stromal invasion was identified at the base of the nodule, leading to the diagnosis of well-differentiated SCC arising from a CHFC. We recommend careful clinical follow-up for patients with relatively large CHFCs as potentially malignant lesions and excision if they show any clinical manifestation