Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma

BACKGROUND: A fistula between the duodenum and the main portal vein near a peptic ulcer is extremely rare, and only two cases of duodenal ulcers have been reported in the past. CASE PRESENTATION: We report a 68-year-old man with a diagnosis of anemia who had a history of extended right hepatectomy for hilar cholangiocarcinoma 20 months previously. The first endoscopic examination revealed a giant peptic ulcer with active bleeding at the posterior wall of the duodenal bulbs, and hemostasis was performed. Endoscopic treatment and transarterial embolization were performed repeatedly because of uncontrollable bleeding from the duodenal ulcer. Nevertheless, he died of sudden massive hematemesis on the 20(th )hospital day. At autopsy, communication with the main portal vein and duodenal ulcer was observed. CONCLUSION: It should be borne in mind that the main portal vein is exposed at the front of the hepatoduodenal ligament in cases with previous extrahepatic bile duct resection

Prediction of postoperative liver regeneration from clinical information using a data-led mathematical model

Although the capacity of the liver to recover its size after resection has enabled extensive liver resection, post-hepatectomy liver failure remains one of the most lethal complications of liver resection. Therefore, it is clinically important to discover reliable predictive factors after resection. In this study, we established a novel mathematical framework which described post-hepatectomy liver regeneration in each patient by incorporating quantitative clinical data. Using the model fitting to the liver volumes in series of computed tomography of 123 patients, we estimated liver regeneration rates. From the estimation, we found patients were divided into two groups: i) patients restored the liver to its original size (Group 1, n?=?99); and ii) patients experienced a significant reduction in size (Group 2, n?=?24). From discriminant analysis in 103 patients with full clinical variables, the prognosis of patients in terms of liver recovery was successfully predicted in 85–90% of patients. We further validated the accuracy of our model prediction using a validation cohort (prediction?=?84–87%, n?=?39). Our interdisciplinary approach provides qualitative and quantitative insights into the dynamics of liver regeneration. A key strength is to provide better prediction in patients who had been judged as acceptable for resection by current pragmatic criteria

Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients.Methods: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 min of standard rehabilitation (conventional occupational therapy) and 40 min of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 min of standard rehabilitation and 40 min of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 min of robotic therapy and 20 min of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at 5 and 10 Weeks. The registration number of this study is UMIN000022509.Conclusions: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis

Clinical Evaluation with Referrence to Operative Specificity on Tracheal and Bronchial Reconstruction

The clinical specificity were evaluated in those 11 cases who underwent tracheal recon - structive surgery and in those 25 cases who underwent bronchial reconstructive surgery respectively. Its prognosis after tracheal reconstruction at the level of intrathoracic region was extremely poor. The operative specificity with regard to tracheal surgery consist of being a poor genera- condition preoperativelly and of having an urgent demand of removal of tracheal stenotic lesion to alleviate respiratory distress . The prognosis after tracheal surgery was commonly poor and was similar to that after emergency operation as a general accep - tance for the reason of unfavorable general condtion . The present study was to define clinical problems in which the salvage after tracheal surgery was entirely difficult. The improvement of the prognosis following tracheal surgery should be found in maximum endeavor for prevention of postoperative complication related to operative death intimately. However, terminal tracheostomy employed for lesions of cervical trachea was one o

The Effect of Surgical Repair for Pectum Excavatum on Cardiopulmonary Function

In five patients with corrective surgery for pectus Excavatum, the effectiveness of surgical repair were evaluated from the results of pulmonary function test as well as the finding on ECG according to follow-up study postoperativelly. Of five patient undergone the corrective surgery which sternoturnover with costalplasty employed in 4, and sternoplasty alone in I, all of them were male and the average age except 3 years of age was 14.8 years ranging from 10 to 21 years. There are no manifestation of clinical syndrome in all 5 cases. However, the fair mental growth demands psychologically the early corrective surgery in young chidren. By follow-up study after surgical correction for pectus excavatum during a period from 3 months to 3 years and 3 months, the finding on EKG of right ventricular overload revealed the improvement within 2 months after surgical correction in contrast the results of pulmonary function test disclosed no marked changes until 2 months following surgery. From the view of cosmetic efficacy of corrective surgery, sternoturnover with or without costalplasty are one of the adovocating operative procedures

ヒト口腔粘膜受容器からの感覚入力による随意性嚥下の促進効果

Both voluntary and reflex components are involved in normal swallowing. Swallowing depends on the bulbar central pattern generator (CPG). Therefore, the relationship between the voluntary component (central input) and reflex component (sensory input) may be important to understand the central mechanisms for deglutition. There are water receptors, mechanoreceptors (tactile receptors and deep mechanoreceptors) and taste receptors in the oral mucosa. In this study, the role of sensory receptors in voluntary swallowing was investigated. Twenty healthy volunteers (mean±SD, 28.9±9.7 years) were enrolled in this study. A fine tube was inserted into the pharyngolaryngeal region (PL) or the tongue base (TB). Stimulating solution at room temperature was delivered into the PL or the TB through this tube. Each subject was instructed to repeat swallowing as fast as possible. EMG activity was recorded from suprahyoid muscles during swallowing. The swallowing interval (SI) between two consecutive swallows in each infusion was measured. SIs were shorter in the case of water infusion into the PL than in the case of water infusion into the TB, suggesting that water receptors are localized in the PL. Infusion of 0.15M NaCl into the PL prolonged SI, because 0.15M NaCl inhibits water receptors. However, infusion of 0.15M NaCl into the TB shortened SI, suggesting that excitation of Na^+taste receptors can facilitate voluntarily swallowing. SI with resting saliva infusion into the PL was almost the same as that with water infusion, suggesting that resting saliva can excite water receptors. In the weak mechanical stimulation (infusion rate of 0.2ml/min), SIs varied greatly from subject to subject. Therefore, the variation in SI cannot be explained by difference in sensitivity of the mucosal receptors among subjects. It appears that the ability of CPG to perform repetitive voluntary swallowing varies greatly in subjects. The strong mechanical stimulation (infusion rate of 5.0ml/min) did not influence SI in a subject showing short SI with the weak stimulation, but it shortened SI in a subject showing long SI. This suggests that excitation of oral mucosal receptors strongly compensates for difficulty in swallowing in subjects showing a long SI

The ASTRO-H X-ray Observatory

The joint JAXA/NASA ASTRO-H mission is the sixth in a series of highly successful X-ray missions initiated by the Institute of Space and Astronautical Science (ISAS). ASTRO-H will investigate the physics of the high-energy universe via a suite of four instruments, covering a very wide energy range, from 0.3 keV to 600 keV. These instruments include a high-resolution, high-throughput spectrometer sensitive over 0.3-2 keV with high spectral resolution of Delta E < 7 eV, enabled by a micro-calorimeter array located in the focal plane of thin-foil X-ray optics; hard X-ray imaging spectrometers covering 5-80 keV, located in the focal plane of multilayer-coated, focusing hard X-ray mirrors; a wide-field imaging spectrometer sensitive over 0.4-12 keV, with an X-ray CCD camera in the focal plane of a soft X-ray telescope; and a non-focusing Compton-camera type soft gamma-ray detector, sensitive in the 40-600 keV band. The simultaneous broad bandpass, coupled with high spectral resolution, will enable the pursuit of a wide variety of important science themes.Comment: 22 pages, 17 figures, Proceedings of the SPIE Astronomical Instrumentation "Space Telescopes and Instrumentation 2012: Ultraviolet to Gamma Ray

The Quiescent Intracluster Medium in the Core of the Perseus Cluster

Clusters of galaxies are the most massive gravitationally-bound objects in the Universe and are still forming. They are thus important probes of cosmological parameters and a host of astrophysical processes. Knowledge of the dynamics of the pervasive hot gas, which dominates in mass over stars in a cluster, is a crucial missing ingredient. It can enable new insights into mechanical energy injection by the central supermassive black hole and the use of hydrostatic equilibrium for the determination of cluster masses. X-rays from the core of the Perseus cluster are emitted by the 50 million K diffuse hot plasma filling its gravitational potential well. The Active Galactic Nucleus of the central galaxy NGC1275 is pumping jetted energy into the surrounding intracluster medium, creating buoyant bubbles filled with relativistic plasma. These likely induce motions in the intracluster medium and heat the inner gas preventing runaway radiative cooling; a process known as Active Galactic Nucleus Feedback. Here we report on Hitomi X-ray observations of the Perseus cluster core, which reveal a remarkably quiescent atmosphere where the gas has a line-of-sight velocity dispersion of 164+/-10 km/s in a region 30-60 kpc from the central nucleus. A gradient in the line-of-sight velocity of 150+/-70 km/s is found across the 60 kpc image of the cluster core. Turbulent pressure support in the gas is 4% or less of the thermodynamic pressure, with large scale shear at most doubling that estimate. We infer that total cluster masses determined from hydrostatic equilibrium in the central regions need little correction for turbulent pressure.Comment: 31 pages, 11 Figs, published in Nature July