Three cases of groove pancreatic carcinoma in which endoscopic ultrasonography was useful for diagnosis before surgery

We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonography revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.     

Ileal schwannoma in which blood loss scintigraphy was useful for diagnosis

An 85-year-old woman was hospitalized with severe melena of unknown origin. Upper gastrointestinal (GI) endoscopy and lower GI endoscopy did not detect the origin and we could not establish any diagnosis. To explore the bleeding site, 99mTc-HSA blood loss scintigraphy was performed and a tumor of the small intestine was suspected. Fluoroscopic examination of the small intestine and abdominal CT scan confirmed an ileal tumor measuring 4x3 cm. The mass was a well-demarcated tumor about 80 cm proximal to Bauhin's valve. Partial resection of the ileum was carried out and the tumor was histologically diagnosed as schwannoma. Thereafter, there has been no recurrence of melena nor metastasis of the tumor. It is thought that blood loss scintigraphy is a useful method for unexplained exacerbation of melena.     

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases

Background and aimsVibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level.MethodsOver a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus.ResultsThe development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%.ConclusionRecognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.     

Vibrio vulnificus infection: clinical and bacteriological analysis of four cases

Vibrio vulnificus (V. vulnificus) infection has recently been drawing attention as a high mortality disease especially in a patient with the preexisting chronic liver disease. The illness caused by V. vulnificus is divided into three groups such as primary septicemia, wound infection and gastrointestinal illness. Primary septicemia, which is the most common in Japan, is defined as a systemic illness presenting fever or hypotension with recovery of V. vulnificus from blood or tissue without the apparent primary focus of infection. We diagnosed four cases as infectious diseases of V. vulnificus by isolating it from each clinical material in Kurashiki Central Hospital from 1984 through 1997. We investigated clinical manifestations of the four cases including season of the onset, presence of drinking habit, underlying diseases, consumption of raw seafood, symptoms, presence of disseminated intravascular coagulation (DIC) or shock, laboratory data, administered antibiotics and the outcomes of the treatment. And for each strain, we also performed in vitro drug susceptibility tests. The age of the patients ranged from 49 to 61 years old (mean 56), and all of the patients were male. Each of them had a chronic liver disease as an underlying disease. Two of them had a history of raw seafood consumption prior to the onset of the illness. Skin manifestations appeared in two of the four patients. All the patients complicated septic shock and DIC. V. vulnificus was isolated from the venous blood cultures of them. Three of the four were given a diagnosis of primary septicemia and one was made a diagnosis of acute cholecystitis which has never been reported previously. Three of the four patients died and only the rest was alive as a result of antimicrobial therapy. In the sensitivity tests, the four strains were revealed to be very sensitive to the antimicrobials such as minocycline, cephalosporins of the third generation and carbapenems. Once patients with a chronic liver disease are infected with V. vulnificus, their prognosis is poor. Every effort should be made to advise not to have uncooked seafood. Physicians should be informed about the characteristics of the disease caused by this bacteria and treat any suspicious case promptly and appropriately.     

A case of pulmonary varices in which enhanced CT was useful for diagnosis]

A case of pulmonary varices in a 73-year-old female is presented. Routine chest X-ray revealed a mass in the right hilar region. CR tomogram showed a round, clearly defined mass at the right hilum. Computed tomography demonstrated marked enlargement of the proximal portion of the pulmonary vein at the entrance of the left atrium, which was suspected to be pulmonary varices. The diagnosis was confirmed by pulmonary angiography. During the arterial phase no abnormal findings were seen, but during the venous phase the veins of the right upper and middle lobes were found to be draining into the dilated pulmonary vein and then into the left atrium. Thus, the diagnosis of pulmonary varices was established. CT and angiography are the most useful methods for definitive diagnosis of pulmonary varices.     

Melioidosis of the spleen diagnosed by 16S rDNA amplification and sequencing

We present the case of a 51-y-old male with multiple splenic abscesses that failed to resolve despite antimicrobial therapy targeted at Burkholderia pseudomallei. Elective splenectomy was performed to clarify the diagnosis. Pus from the spleen was subjected to universal bacterial 16S rDNA amplification and sequencing. The sequence obtained was 99% identical to 16S rDNA sequences for Burkholderia pseudomallei. Sequencing of the 16S rDNA is a very promising diagnostic tool allowing quick identification of Burkholderia pseudomallei directly from clinical specimen.     

A case report of segmental arterial mediolysis in which computed tomography angiography was useful for diagnosis

A 48-year-old male presented to our hospital with abdominal pain. Laboratory studies showed no abnormality, the severity of his abdominal pain decreased, and the patient was discharged. Five days later, the patient visited a neighborhood clinic because of fever with a 3-day history of temperatures of approximately 38 °C. The patient was admitted to our hospital 6 days after his initial visit. Laboratory investigation revealed a C-reactive protein level of 18.2 mg/dL. Abdominal computed tomography (CT) showed an 80 × 60 mm hematoma behind the descending colon, but no extravasation was detected. Thin-slice maximum-intensity-projection images from CT angiography (CTA) showed irregular narrowing and intermittent fusiform dilatations of the left colonic artery, suggesting a vascular disease, such as segmental arterial mediolysis (SAM). Digital subtraction angiography showed local irregularity, and ‘beading and narrowing’ of the left colonic artery, similar to the findings on CTA. Left hemicolectomy was electively performed on the twenty-fifth hospital day. Histological findings were consistent with SAM. Thus, CTA was a useful modality for the early diagnosis of SAM.     

A collective review of Vibrio vulnificus infection in Japan

Vibrio vulnificus is found globally in marine coastal waters. Infection with this organism, via ingestion of raw shellfish or exposure to marine water, can cause necrotizing fasciitis and sepsis, which have high mortality and short latency. In Japan, many cases have been reported since 1980, mainly from hospitals in western prefectures. However, because of the sporadic nature of infection outbreaks, a thorough epidemiologic survey has not been done. We studied the epidemiological and clinical characteristics of Vibrio vulnificus infections reported in Japan from 1975 to 2005. We identified 185 cases using the medical article search engines Ichushi (Japan Medical Abstracts Society), CiNii (Citation Information by National Institute of Informatics), and PubMed over 30 years. The median age of patients was 59. The number of male patients was eight times the number of female patients; however, no significant difference in mortality was found between genders. In yearly distributions of patients, 20 cases were reported in 2001, a year in which we experienced more rainfall and a longer rainy season in Northern Kyushu. In monthly distribution, about 80% of cases were reported from July to September when sea water temperatures rise. About 40% of cases were reported in four prefectures around the Ariake Sea. The underlying disease indicated liver dysfunction in 90% of patients, but mortality was the same regardless of the infection pathway (oral ingestion or wound). Because of its rapid aggravation and high mortality rate, public education is important to prevent new cases. It is also highly recommended that patients with preexisting liver dysfunction avoid raw fish and limit exposure to marine water during the summer.     

基于微生物16S rDNA测序技术研究高脂血症豚鼠肠道菌群的变化

目的利用微生物16S rDNA测序技术研究高脂血症豚鼠肠道菌群的变化情况。方法豚鼠随机分为对照组和模型组,每组10只。高脂喂养8周复制高脂血症模型。第8周末测定豚鼠血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)和高密度脂蛋白胆固醇(HDLC)水平;剖取肝脏、主动脉和结肠,HE染色观察肝脏、主动脉和结肠组织形态学变化; 16S rDNA测序检测豚鼠肠道内容物微生物组成和比例的变化情况。结果与对照组相比,模型组豚鼠血清TC、TG、LDLC和HDLC水平均显著升高(P0.01);组织形态学显示,模型组豚鼠均出现重度脂肪肝病变,但仅1只模型组豚鼠出现少量泡沫细胞聚集。16S rDNA基因序列分析显示,与对照组相比,在门分类学水平上,模型组豚鼠肠道互养菌门细菌比例显著增加(P0.05);在属分类学水平上,模型组豚鼠肠道毛螺旋菌NK4A136、瘤胃球菌、幽门螺杆菌、Odoribacter、Allobaculum和Caldicoprobacter细菌比例显著降低(P0.05),依赖杆菌、毛螺旋菌XPB1014、锥形杆菌和Enterorhabdus细菌比例明显升高(P0.05)。结论高脂血症豚鼠肠道菌群的组成及比例发生了明显变化。该实验结果为基于肠道菌群研究高脂血症作用机制奠定了理论基础。     

The changes of gut microbiota of hyperlipemia guinea pigs by microbial 16S rDNA sequencing

<正>Objective To study the changes of gut microbiota of hyperlipemia guinea pigs by microbial 16S r DNA sequencing. Methods Guinea pigs were randomly divided into normal group and model group,with 10 in each group.Guinea pig models of hyperlipidemia were established by high fat diet. After feeding for 8 weeks,serum total cholesterol (TC),triglyceride (TG),low density     

Two cases of hemosuccus pancreaticus in which hemostasis was achieved by transcatheter arterial embolization

Hemosuccus pancreaticus is a rare complication of chronic pancreatitis. We report two cases of hemosuccus pancreaticus in which hemostasis was achieved by transcatheter arterial embolization (TAE). The first patient was a 47-year-old man with alcoholic chronic pancreatitis. He presented with upper abdominal pain and hematemesis. Upper GI endoscopy failed to detect the source of bleeding, but computed tomography (CT) showed a hypervascular area about 3?cm in diameter in a pseudocyst at the pancreatic tail. Angiography revealed a pseudoaneurysm in the caudal pancreatic artery. Hematemesis was considered to be due to rupture of the pseudoaneurysm. TAE of the splenic artery was performed selectively, and this successfully stopped the bleeding. The second patient was a 52-year-old man with alcoholic chronic pancreatitis. He presented with hematemesis. Upper GI endoscopy detected bleeding from the papilla of Vater. CT showed hemorrhage in a pseudocyst at the pancreatic body. Angiography revealed angiogenesis around the pseudocyst. Hematemesis was considered to result from rupture of the pseudoaneurysm. TAE of the dorsal pancreatic artery and posterior superior pancreaticoduodenal artery was performed and hemostasis was achieved. We conclude that TAE is a minimally invasive and highly effective treatment for hemosuccus pancreaticus.     

Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment.

From May 1985 through July 1990, 28 episodes of Vibrio vulnificus infection in 27 patients were encountered in five major hospitals in Taiwan. The ages of patients ranged from 19 to 76 years; the ratio of male to female patients was 2:1. Eighteen episodes manifested as bacteremia and eight as wound infections alone. One patient each developed gastroenteritis and pneumonia after nearly drowning. Twenty-three patients exhibited skin manifestations. Twenty patients had underlying diseases. All patients were treated with antibiotics, and 14 also underwent some form of surgical treatment (incision and drainage, fasciotomy, debridement, or amputation). Thirteen of the 28 episodes were preceded by precipitating factors; most were due to ingestion of seafood or exposure of abraded skin to salt water. Ten of the 18 septicemic patients died--most within 48 hours of hospitalization. One patient without bacteremia who had a wound infection died. Results of in vitro susceptibility studies suggested that ampicillin or a third-generation cephalosporin would be effective. Susceptibility to aminoglycosides was observed for greater than 90% of isolates. We recommend combined therapy with a third-generation cephalosporin or ampicillin and an aminoglycoside along with appropriate surgical therapy for the treatment of V. vulnificus infection.     

炎症性肠病肠道黏膜细菌谱的研究

目的以16S-rDNA基因序列测定方法研究日本炎症性肠病（inflammatoryboweldisease,1BD）患者与正常对照肠镜标本中细菌构成谱。方法纳入2010年11月-2011年6月在日本名古屋大学附属病院接受肠镜检查患者14例,其中4例活动期溃疡性结肠炎（ulcerativecolitis,UC）患者（8个标本）,3例缓解期UC（5个标本）,2例活动期克罗恩病（Crohn’Sdisease,CD）（4个标本）,和正常对照5例（10个标本）,共收集肠镜27个标本。应用16S-rDNA基因序列测定方法检测肠道黏膜细菌谱。比较不同组间、不同部位标本的细菌构成差异。结果共取得796个细菌16S-rDNA基因序列。这些序列分属于5个门（phylum）：厚壁菌（Firmicutes）、拟杆菌（Bacteroidetes）、变形杆菌（Proteobacteria）、梭杆菌（Fusobacteria）和未分类细菌（unclassifiedBacteriao活动期UC组和活动期CD组中厚壁菌门细菌构成比低于缓解期UC组和正常对照组。CD组中细菌种类减少,CD组中变形杆菌门细菌高于UC组和对照组。结论本研究证实了IBD组肠道黏膜细菌构成谱不同于正常对照组,且有细菌种类减少趋势。