Intraductal Papillary Tumors of the Pancreas: Evaluation With Magnetic Resonance Cholangiopancreatography

Objective : We analyzed the findings of intraductal papillary tumors of the pancreas by magnetic resonance cholangiopancreatography (MRCP). Methods : Twelve patients with intraductal papillary tumors (main duct type,   n = 3  ; branch duct type,   n = 8  ; combined type,  n = 1  ) underwent endoscopic retrograde cholangiopancreatography (ERCP) (  n = 11  ) and MRCP, using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences (  n = 12  ). Imaging findings were compared with operative and pathological findings in all the patients. Results : Although ERCP failed to fully depict the main pancreatic duct and cystic tumors in six of 11 patients because of copious intraductal mucin, MRCP provided complete images of these structures in all 12 patients. In main duct type tumors, MRCP demonstrated moderate-marked, diffuse dilation of the main pancreatic duct. Branch duct type tumors showed "grape-like" clusters of cysts with no or only mild, diffuse dilation of the main duct. In combined type tumors, MRCP demonstrated a markedly dilated main duct with a large unilocular cyst of the collateral duct. MRCP detected more mural nodules (75%, three of four patients) than ERCP (25%, one of four). MRCP allowed more precise diagnosis of the type, size, and extent of tumors than ERCP, as confirmed by pathologic findings. Conclusion : MRCP demonstrates intraductal papillary tumors less invasively and more completely than ERCP.     

Papillary Cystadenocarcinoma of the Pancreas

Papillary cystadenocarcinoma is a rare lesion of the pancreas. A case is reported in a 38-year old female where radical resection of an extensive lesion resulted in a four-year survival without evidence of recurrence.     

Megakaryocytopoiesis in Rats With Special Reference to Polyploidy

The morphologic stage of maturation, ploidy level, and cell size of individual megakaryocytes from the marrow of normal rats were determined;the initial labeling index of this population of megakaryocytes 30 minutes afterinjection of ³HTdr was also determined. The results suggested some inferencesabout the flow of cells through the various ploidy and differentiation compartments during the maturation of megakaryocytes. Most 8N Type-I megakaryocytes endoreduplicate and become 16N Type-I cells, while a fewmature to 8N Type-II megakaryocytes. Most 16N I cells mature to 16N IIalthough a few endoreduplicate to become 32N I cells; the 32N I cells matureonly to 32N II. The Type-I morphologic stage contains two subcompartmentsthat we have not distinguished morphologically, an endoreduplicating subcompartment and a post-DNA-synthesis subcompartment. The time parameterof the latter ranges from about nine to 19 hours. The time parameter of theformer depends on the number of endoreduplications undergone by an individual megakaryocyte. The size of megakaryocytes increases both with increases in ploidy level and with cell differentiation.

Submitted on October 23, 1969 Accepted on January 14, 1970     

Agenesis of the Dorsal Pancreas and Associated Diseases

Background Agenesis of the dorsal pancreas is a very rare congenital pancreatic malformation and is associated with some other diseases. Methods A PubMed search revealed 53 cases of agenesis of the dorsal pancreas. Results In 28 patients with this congenital malformation hyperglycemia was demonstrated, 27 had abdominal pain, 16 had pancreatitis, 14 had an enlarged or prominent pancreatic head visible on computed tomography, and in a few cases, polysplenia, which may occur with various congenital anomalies of visceral organs, was described. Conclusions Difficulties involved in obtaining a firm diagnosis have led to a variety of terms being used to describe this congenital disease. Diagnosis of agenesis of the dorsal pancreas is inconclusive without demonstration of the absence of the dorsal pancreatic duct. Here we describe the embryological development of the pancreas, the so-far known cases of agenesis of the dorsal pancreas with associated medical problems, and the diagnostic measures to find the right conclusions.     

Autoantibodies in Acquired Hemolytic Anemia With Special Reference to the LW System

Most autoantibodies in patients with warmantibody autoimmune hemolytic anemia(AIHA) have specificity within the Rh system. Using rare cells such as -D- andRh_null cells, Weiner and Vos (1963) described specificity against normal cells (nl),partially deleted cells (pdl), and deletedcells (dl). Recently, autoantibodies whichfailed to react with Rh_null cells that were ofanti-U specificity have been described. Itwas suggested that the "Rh related" autoantibodies that cannot be identified asspecific Rh antibodies may be anti-U. Inthe present study we examined eluatesfrom the red cells of eight patients withAIHA using a panel of extremely rare cellsand cross-absorption and elution techniques. We demonstrated autoantibodyspecificities not definable without the rarecells and, further, defined heterogeneity ofthe LW antigen. Autoantibodies with Uspecificity occurred in three eluates only.It was always present with an antibody ofanother specificity. Six of the eluates contained anti-LW, two anti-nl, five anti-pdl,three anti-dl, and one anti-e. Absorptionand elution studies using the rare Rh-positive LW-negative (Mrs. Bigelow)showed that anti-pdl may in fact representanti-LW + LW₁ and that Mrs. Bigelowmay represent a weak variant of LW. Injection of her red cells into guinea pigsproduced an anti-LW that reacted similarlyto the antibody produced by injecting Rh-positive LW-positive cells. An analogy tothe ABO is suggested that normal Rh-positive LW-positive cells represent LW₁,Rh-negative LW-positive cells representLW₂, Mrs. Bigelow represents LW₃ andRh_null cells represent the only true LW-negative (lw).

Submitted on January 19, 1973 Revised on March 5, 1973 Accepted on March 6, 1973     

Pseudocyst of Ectopic Pancreas of the Duodenal Wall Masquerading as Malignant Cystic Tumor of Pancreas

We report a patient who underwent pancreaticoduodenectomy for a cystic lesion in the region of the pancreatic head and duodenum. Preoperatively, we had suspected a malignant lesion; however, it turned out to be ectopic pancreatic tissue in the duodenal wall, with the changes of chronic pancreatitis and pseudocyst formation. With this report we seek to highlight the rarity of this particular pathologic combination and the difficulties in its correct preoperative diagnosis and management.     

Trend of Blood Pressure Control Status in Hypertensive Outpatients: With Special Reference to Elderly Hypertensives

Blood pressure (BP) control in hypertensives has improved; however, it still remains to be insufficient. We have investigated the trend in BP control status of the hypertensive patients followed for 10 years in hypertension clinic. Subjects included 133 patients who have been followed from the first visit during 1998–2000 to the last visit during 2008–2010. During the mean follow-up period of 10.5 years, average BP and body weight significantly (P < .01) decreased from 143 ± 12/85 ± 8 mm Hg to 129 ± 14/68 ± 11 mm Hg, and from 59.8 ± 9.9 kg to 58.7 ± 10.6 kg, respectively. The achievement rate of good BP control defined as <140/90 mm Hg and the number of antihypertensive drugs also increased significantly during this period (39.1%–77.5% and 1.3 ± 1.0–2.2 ± 1.1, respectively, P < .01). Blood pressure control improved and the number of antihypertensive drugs also increased in 45 patients who were older than 65 years at the last visit. The use of Ca channel blockers (CCBs), angiotensin II receptor antagonists, and diuretics increased significantly during this period. Results suggest that lifestyle modification including body weight reduction as well as intensive antihypertensive treatment contributed to the improved BP control in hypertensive patients including the elderly.     

Cytodifferentiation of the Chick Pineal Gland, With Special Reference to the Photosensory and Secretory Elements

Cytodifferentiation of the chick pineal gland throughout the embryonic development was investigated with light and electron microscopy. The chick pineal anlage appears first as a small evagination in the diencephalic roof at 60 h of incubation (27-30 somites). Until day 5 of incubation, pineal anlage cells are undifferentiated and appear similar to ventricular ependymal cells. Subsequently, pinealocytes and supporting cells are first distinguishable at 7-8 days, and parafollicular cells are distinguishable at 12 days of incubation. Pigment-containing cells after 6 days and nerve cells after 17 days of incubation gradually increase, especially in the posterior wall of the pineal recess. During embryonic development, the chick pineal gland has both photosensory and secretory elements: viz. the former, mitochondria-laden apical protrusions, synaptic ribbons, lamellar whorl-like cilia of the pinealocytes, and adjacent appearance of the pigment-containing cells and the nerve cells; and the latter, dense-cored vesicles of the pinealocytes and dense bodies of the supporting cells. Moreover, nuclear invaginations having a large lipid droplet nearby and some aggregations of glycogen are found in the pinealocytes and are transitory changes in structure restricted to certain days of incubation.     

Role of Endoscopy in the Diagnosis of Papillary Dysfunction

The role of endoscopy in the papillary region was analyzed in order to review the functional disturbances of the papillary region and the mechanism of excretion of bile into the duodenum. There are several procedures for the diagnosis of reversible or irreversible papillitis. Many investigators try to clarify the pathogenesis of papillary dysfunction by using the endoscopic method. Endoscopic manometry fills an important role in evaluating papillary dysfunction. Nevertheless, physiological and pathophysiological investigation of the mechanism of excretion of bile are not satisfactory, and the significance of the effects on the papillary region of gastrointestinal hormones such as cholecystokinin (CCK) is not clear. More studies using the endoscopic method are necessary to elucidate the function of the papillary region.