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

Effects of Different Types of Dietary Fibers on Fermentation by Intestinal Flora

Purpose: A treatment for chronic constipation is dietary fiber intake. This study aimed to determine the effects of different types of dietary fibers on the microbiota in the large intestine. Methods: Nine healthy volunteers participated in this study. Breath hydrogen test was used to determine the dietary fiber fermentations. The presence of hydrogen in the breath indicates intestinal bacterial activities. Participants fasted overnight and ate white bread (200 g) with 10 g of each type of dietary fiber: (1) cellulose, (2) soy fiber, (3) guar gum, and (4) control (without any dietary fiber). Samples were collected before and every 1 hour after eating, for 8 h. Another test compared the effects between cellulose and guar gum with a loaded food, which activates intestinal fermentation, and samples were collected using the same methods. Results: During 8 h of measurements, breath hydrogen concentration in the soy fiber group were higher than that of the control, but were not significantly different. Changes in the guar gum group were similar to those in the control. However, breath hydrogen concentrations in the cellulose group did not increase even after eating white bread that caused large intestinal fermentation 2.9 ± 0.7 ppm, which was significantly lower than that of the guar gum group (7.4 ± 1.7 ppm, p < 0.01). In the study with a well-fermented food intake, cellulose reduced breath hydrogen concentrations, but its difference with that of the guar gum group was statistically non-significant. Conclusion: Cellulose might have a suppressive effect on large intestinal fermentation. Therefore, this compound may be beneficial in treating chronic constipation

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

Retrospective Study of the Correlation Between Pathological Tumor Size and Survival After Curative Resection of T3 Pancreatic Adenocarcinoma: Proposal for Reclassification of the Tumor Extending Beyond the Pancreas Based on Tumor Size

BackgroundEven though most patients who undergo resection of pancreatic adenocarcinoma have T3 disease with extra-pancreatic tumor extension, T3 disease is not currently classified by tumor size. The aim of this study was to modify the current TNM classification of pancreatic adenocarcinoma to reflect the influence of tumor size.MethodsA total of 847 consecutive pancreatectomy patients were recruited from multiple centers. Optimum tumor size cutoff values were calculated by receiver operating characteristics analysis for tumors limited to the pancreas (T1/2) and for T3 tumors. In our modified TNM classification, stage II was divided into stages IIA (T3aN0M0), IIB (T3bN0M0), and IIC (T1-3bN1M0) using tumor size cutoff values. The usefulness of the new classification was compared with that of the current classification using Akaike’s information criterion (AIC).ResultsThe optimum tumor size cutoff value distinguishing T1 and T2 was 2 cm, while T3 was divided into T3a and T3b at a tumor size of 3 cm. The median survival time of the stages IIA, IIB, and IIC were 44.7, 27.6, and 20.3 months, respectively. There were significant differences of survival between stages IIA and IIB (P = 0.02) and between stages IIB and IIC (P = 0.03). The new classification showed better performance compared with the current classification based on the AIC value.ConclusionsThis proposed new TNM classification reflects the influence of tumor size in patients with extra-pancreatic tumor extension (T3 disease), and the classification is useful for predicting mortality

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

Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p=0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC