Differences in the electric potential of pancreatic head cancer tissues

Identifying the electrical properties of cancer relies on the understanding of the electric potential (EP) of cancer tissues. This study aimed to investigate the EP properties in 49 pancreatic head cancer tissues using a digital multimetre. The anode was placed at the central side of the tumour, and the electric potential differences (EPDs) between cancerous and cancerous, cancerous and noncancerous, and noncancerous and noncancerous lesions at approximately 1-cm intervals following resection were evaluated. Pathological evaluation identified 30 of these samples as pancreatic invasive ductal carcinoma (PIDC, 10 without preoperative chemotherapy and 20 after chemotherapy), seven other pancreatic cancers, three tumours of Vater’s ampulla (VA), and eight extrahepatic cholangiocarcinoma (EHCC) samples. We also evaluated the differences in pH for cancerous and noncancerous lesions in nine PIDC samples. Our data suggest that the EP of pancreatic cancerous tissues is higher than that of noncancerous tissues, especially in PIDCs. We also noted that EPD was the highest when comparing cancerous and noncancerous lesions. Additionally, PIDC tissues presented with low pH; the pH difference between cancerous and noncancerous sites was significantly correlated with EPD (P = 0.011). These EPDs were also correlated with tumour size in PIDCs and inversely correlated with their response to chemotherapy. The EP values for both the cancerous and noncancerous sites in both the VA tumours and EHCC samples were not significantly different, whereas EPD in PIDC correlated with tumour extension and viable tumour content, suggesting that EPD might be useful for evaluating the viability and effectiveness of neoadjuvant chemotherapy.This research was partially supported by a Grant-in-Aid for Scientific Research (A) (Nos. 15H02567 and 17H05102) from the Ministry of Education, Culture, Sports, Science, and Technology, and the Ministry of Health, Labour, and Welfare for Japan

Mirizzi Syndrome with a Biliobiliary Fistula : a case report

Mirizzi syndrome is a rare complication of cholelithiasis, which is defined as a common bile duct obstruction due to stones impacted in Hartman’s pouch or the cystic duct of the gallbladder. The impacted stones and surrounding inflammation can lead to a biliobiliary fistula. We herein present the case of a 73-year-old Japanese man with a biliobiliary fistula that was diagnosed peroral cholangiography (POCS). We performed partial cholecystectomy and choledochoplasty as the stone had eroded almost the entire circumference of the bile duct. Postoperative complications included a minor bile leak from the repaired common bile duct apparent on postoperative day 1, which was managed conservatively. The patient was discharged on postoperative day 9. Based on this experience, POCS is useful for detecting the existence of a biliobiliary fistula in cases of Mirizzi syndrome. Once a biliobiliary fistula is confirmed, it is important to select an appropriate surgical procedure based on the extent of common bile duct involvement in the inflammatory process

Use of the Hydrogen Breath Test to Determine the Influence of Antibiotic Prophylaxis on Intestinal Flora

Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible

Vascular resection in distal cholangiocarcinoma: Review of the literature

Vascular resection including portal vein resection and/or hepatic artery resection has rarely been reported in distal cholangiocarcinoma. This review aimed to elucidate the safety and oncological outcomes of surgery with vascular resection in patients with distal cholangiocarcinoma. The following data were extracted from the identified studies: type of vascular resection, surgical outcome, pathological findings, recurrence-free survival (RFS), and overall survival (OS). Six studies were identified, and patients were classified into the vascular resection (VR) group and non-VR group according to the presence or absence of vascular resection in each study. The vascular resection ratios ranged from 6.8% to 20.0% in the surgical cases. The most frequent tumor location in the VR group was the extrapancreatic common bile duct and the most frequent sites of vascular resection were portal vein and right hepatic artery. The ratios of T3 or T4 tumor were significantly higher in the VR group. The ratios of severe complications and postoperative mortality were not significantly different between the VR and non-VR groups. The median RFS time and OS time in the VR group were shorter than 1 year and 2 years, respectively, in all studies. In conclusion, the patients with distal cholangiocarcinoma in the VR group tended to show early recurrence and shorter survival, although vascular resection could be performed safely

Use of the Hydrogen Breath Test to Determine the Influence of Antibiotic Prophylaxis on Intestinal Flora

Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible