Online)

ABSTRACT Context Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention. Case report We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies. Conclusions Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection

International Telemedicine Activities in Thailand

The development of information and communication technology has had a dramatic impact on people’s lives, including medical matters. The Internet has made it possible for telemedicine to be implemented with excellent image quality at low cost; such telemedicine was first applied between Japan and South Korea in 2002. The technology is not restricted to advanced countries: it can also be applied in developing nations, and it has expanded rapidly to other parts of Asia and beyond. In 2005 Thailand became the seventh country to be associated with the Telemedicine Development Center of Asia (TEMDEC). As of 2017, TEMDEC operates 144 programs in Thailand, mainly in endoscopy (55, 38%) and surgery (40, 28%): 17 hospitals or medical institutions are active members, and there are 165 telemedicine connections. Siriraj Hospital, Mahidol University was the first participant; it has 71 telemedicine connections; King Chulalongkorn Memorial Hospital became the second participant; it has 52 such connections. These two hospitals account for 74.5% (123/165) of all telemedicine activities in Thailand. Compared with outside Bangkok, the number of telemedicine connections is 14 times (154/11) greater and the number of such connections per hospital is 10 times (15.4/1.6) greater in the capital-even though the number of hospitals is only 1.4 times (10/7) greater in Bangkok. To efficiently meet local needs, we strongly hope that telemedicine will expand into rural parts of Thailand and into more medical specialties through ongoing technological development

"Fatherless girl and "Domineering mother" : Terayama Shuji's portrayal of women

Thesis (M.A.)--University of Hawaii at Manoa, 2004.Includes bibliographical references (leaves 66-72).ii, 72 leaves, bound ill. 29 cmWhen a girl gives birth, she starts her new life as a mother. In Terayama's theatrical world, a mother, an antithesis of a girl (prostitute), always dominates her own child. Similar to Terayama's own family history, his mother characters always have an only son without having a father figure in the family. In addition, the mother figures always control their sons' lives and dominate them. In addition to the absence of a father figure, the issue of a son who abandons his domineering mother and the images of incest between mother and son frequently show up in Terayama' splays. His portrayals of fatherless or husbandless girls and domineering mothers are especially unconventional compared to the stereotypical portrayals of these figures in many Japanese and Western plays. These two elements, the absence of a father figure and the reign of a ruling mother, are the most important factors and the core themes for the development of Terayama's unique theatrical world. In this essay, I categorize a girl who does not have any such domineering and powerful male figures as the "fatherless girl" and Terayama's powerful and dictatorial mother figure as the "domineering mother." Through these archetypes, I will examine how Terayama assails the traditional notion of female gender roles and their relationships to the male family members' roles

Epitaxial Mn₂VAl films with L2₁-ordered structure for all-Heusler stacks

The structural and magnetic properties of epitaxial Mn₂VAl films grown by molecular beam epitaxy are investigated. Epitaxial Mn₂VAl films with a relatively high L2₁-ordering of ∼0.7 are obtained on MgO(001) substrates at a growth temperature of 350 °C. The saturation magnetic moment at 300 K for the epitaxial Mn₂VAl films is ∼1.2 μB/f.u., which is almost equivalent to the highest value for high-temperature-grown thin-film samples reported previously. Due to the low-temperature synthesis of L2₁-Mn₂VAl, an epitaxial all-Heusler L2₁-Mn₂VAl/L2₁-Fe₂VAl/L2₁-Mn₂VAl trilayer with sharp heterointerfaces is obtained. This study presents the possibility of all-Heusler current-perpendicular-to-plane giant magnetoresistive devices with high performance.Shinya Yamada, Kohei Kudo, Ryosuke Sadakari, Kohei Hamaya, Epitaxial Mn₂VAl films with L2₁-ordered structure for all-Heusler stacks, Journal of Magnetism and Magnetic Materials, 561, 2022, 169644

Endoscopic management of a difficult common bile duct stone

Endoscopic sphincterotomy and lithotripsy using a lithotripter basket have evolved as successful methods to manage bile duct stones. Endoscopic methods reduce morbidity associated with open or laparoscopic surgery