Arthralgia and Osteolytic Lesions Associated with Traumatic Pancreatitis in a 10-Year-Old Girl

A case of traumatic pancreatitis with subsequent joint pain and osteolytic lesions is presented. A 10-year-old girl was admitted to our hospital with abdominal pain caused by blunt epigastric injury. She was diagnosed with traumatic pancreatitis, and multiple pancreatic pseudocysts subsequently developed. Two weeks after admission, she complained of joint pain, and MR revealed osteolytic lesions of both knee joints. On the 58th day, endoscopic transgastric pseudocyst drainage was performed. Joint pain and osteolytic lesions resolved rapidly, in parallel with the decrease in serum amylase level and pseudocyst size

Percutaneous transhepatic electrohydraulic lithotripsy for intrahepatic bile duct stones after choledochal cyst excision

Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation of intrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochal cyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Various procedures have been reported as treatments for postoperative bile duct stone formation. We report a case in which percutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed after choledochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy when he was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performed in our emergency department revealed intrahepatic bile duct stones in minimally dilated intrahepatic bile ducts in both lobes. Percutaneous transhepatic cholangiography showed packed stones distal to the right hepatic duct and stenosis of the right hepatic duct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporeal shockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were not small enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwent percutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHL is an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision

Recruitment of distinct immune cell populations to the lung after intratracheal TLR4 signaling activation by two different stimulations

The toll-like receptor 4 (TLR4)-mediated immune response is considered as one of the triggers of acute respiratory distresssyndrome. The agonistic monoclonal antibody UT12 specific for the TLR4/MD2 complex induces immune activation in a mannerdistinct from lipopolysaccharide (LPS). In order to compare the effects of this differential TLR4 signaling activation, we examinedimmune cell recruitment to the lung following intratracheal inoculation with UT12 and LPS in mice. The increase in pulmonaryneutrophils was much higher after LPS treatment compared with UT12 treatment, while CD11bhiCD11＋cells increased to similarlevels following both treatments. These changes were MyD88-dependent and TRIF-independent. These differential effects onimmune cell recruitment to the lung suggest distinct underlying mechanisms in response to TLR4 stimulation. These findingsfurther indicate that TLR signaling can lead to different outcomes depending on the ligand and activation pathway, which mayrelate to the complex pathogenesis of inflammatory lung diseases

Characterization of waves of leukocyte recruitment to the lung allograft and the effect of CTLA4-Ig

MHC-mismatched lung allografts are rapidly rejected by the host immune response. We analyzed cells infiltrating the grafted lung tissue using a collagenase-digestion method. The grafted lung was filled with host-derived leukocytes as early as day 1 post transplantation and the majority of the initial infiltrating cells were granulocytes. This initial influx of granulocytes waned rapidly, followed by a steady increase in lymphocytes, particularly T cells, and then by macrophages. The proportion of CD4+ T cells that express CD25 were increased in the graft the majority of which were activated CD4+ cells. We applied cytotoxic T-lymphocyte-associated antigen 4 (CTLA4)-Ig treatment in combination with donor-specific blood transfusion to the transplantation of lung allograft, which was significantly prolonged by the treatment. To examine the cellular and molecular basis of the inhibition of the graft rejection, we evaluated number and cytokine mRNA expression of the cells infiltrating in the lung allograft using collagenase-digestion method, although we were unable to detect significant effects of the treatment. Taken together, this study demonstrates that single cell suspensions from cellular infiltrates of lung tissue is useful for phenotypical and functional studies on cells infiltrating lung tissue after graft transplantation

Clinical Significance of Measuring Urinary Sulfated Bile Acids in Adult Patients with Hepatobiliary Diseases.

Background/Aims: Measurement of urinary sulfated bile acid (USBA) level is a simple urine test that reflects the degree of cholestasis in newborns. The aim of this study was to clarify the clinical significances of this test for liver diseases in adults. Methodology: We examined the relationship between USBA level in a urine sample by enzymatic assay and clinical parameters and postoperative complications in 27 patients with hepatobiliary diseases who underwent surgical procedures between 2002 and 2007. Results: Mean USBA in all patients before surgery was 39.8 ± 64.0 μmol/L (median value was 6.6). USBA level was increased in patients with cholestasis. USBA level was significantly correlated with serum total bile acid, total bilirubin level and serum hyaluronic acid level (r=0.850, 0.602 and 0.504, respectively) (p<0.05) and, furthermore, tended to be correlated with liver-uptake ratio (LHL15) by technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy and alanine aminotransferase level (r=-0.469 and 0.436, respectively but not significant). USBA level tended to be associated with postoperative uncontrolled ascites (p=0.050, not significant). Postoperative USBA level by day 7 was not changed; however, USBA level in patients with cholestatic diseases was decreased Conclusions: USBA is a simple and sensitive noninvasive test for cholestasis and also useful to predict postoperative uncontrolled ascites after hepatic resections

Pectus Excavatum Repair: Review of 80 Cases in 32 years

We examined the results for pectus excavatum (PE) repair using conventional methods?sternal elevation by modified Ravitch procedure (SEMR), sternal elevation elevation by metal struts (SEMS), sternal turnover (ST) and costoplasty (CP)?and minimally invasive repair of PE (MIRPE) in 80 patients (65 boys and 15 girls) operated between July 1972 and March 2005 at the First Department of Surgery, Nagasaki University Hospital. Of 80 patients, 23 (28.8%) had asymmetric PE, while 57 (71.2%) had symmetric PE. The medians of cosmetic appearance index, functional impairment index and CT index were 0.022, 0.160 and 5.0395, respectively. A significant (p<0.0001) difference was observed among the operative methods for operating time, blood loss and hospital stay; the median of operating time was 85, 252.5, 145, 170 and 170 min for MIRPE, ST, CP, SEMR and SEMS, respectively; the median of blood loss was 5, 299.5, 243, 105.5 and 547.5 mL for MIRPE, ST, CP, SEMR and SEMS, respectively; the median of hospital stay was 10, 18.5, 30.5, 9.0 and 23.5 days for MIRPE, ST, CP, SEMR and SEMS, respectively. Postoperative complications were noted in 23 patients (28.8%), and the most common complication was wound infections. Epidural analgesia was used for postoperative pain control in 12 (75.0%) of 16 patients receiving MIRPE and 4 (7.7%) of 52 patients receiving ST in 1991 or later. The present study suggests that SEMR and MIRPE will be most versatile methods for children among the 5 operation procedures because of minimum invasion and short hospital stay; MIRPE has advantages that it has no incision of anterior chest wall and that it does not require resection of rib cartilages