Changes in optic glass-fibers due to X-ray irradiation.

The purpose of this study was to clarify the relationship between x-ray irradiation and changes in the functional properties of flexible fiberscopes. Scanning electron microscopy, electron spin resonance, and thermoluminescent dosimetry techniques were used to determine the nature of the changes and their possible reversibility. Decreases in light transmission were observed at exposures above 5 roentgens (R), color changes were observed above 25 R, and electron spin resonance absorption changes occurred above 100 R. These changes were proportional to the x-ray doses. The x-ray exposure rates of the segmental and the subsegmental bronchi are about 20 percent that of the patient's thoracic skin surface. The above-mentioned studies showed that, for optimal results, a fiberscope should not be exposed to more than 15 minutes of fluoroscopy by a TV apparatus per week.     

Clinical Application of Magnetoencephalography in a Patient with Corticobasal Degeneration

Previous neuroimaging studies in corticobasal degeneration (CBD), such as MRI and positron emission tomography, showed lateralized cortical atrophy and a decrease in cortical oxygen metabolism, respectively. The advantage of magnetoencephalography in the research of the auditory system is that activity of both hemispheres can be detected separately. Auditory-evoked magnetic fields (AEFs) were then applied to a patient with corticobasal degeneration. The strength of N1 OOm equivalent current dipoles (ECD) in left hemisphere was extremely smaller (20 nAm) than that in right hemisphere (48 nAm). This results implies that CBD patient might have a decrease in the number of neurons in the primary auditory cortex. This study suggests that AEF measurement is one of the most powerful tools for detecting latent impairment of auditory function in patients with corticobasal degeneration.     

Secular Trends in the Background of Intracerebral Hemorrhage from 2010 to 2015

Objective

Direct oral anticoagulants (DOACs) were recently introduced for the clinical use in stroke prevention, and they are reported to show a lower risk of intracerebral hemorrhage (ICH) compared to warfarin. We were interested to know whether there is any change in clinical backgrounds of ICH patients to date.

Undetected hepatocellular carcinoma in patients undergoing liver transplantation: is associated with favorable outcome

BACKGROUND/AIMS: The aim of the study was to define the clinical characteristics and outcome of patients found to have undetected hepatocellular carcinomas (HCC) at liver transplantation. Patients who underwent liver transplantation and were unexpectedly found to have a HCC despite prior workup showing normal alpha-fetoprotein levels and/or no visible radiological lesion were defined as having an undetected HCC. METHODOLOGY: Thirty-two of these patients had a histological diagnosis of HCC in the explanted liver. Undetected HCC was defined as a carcinoma found only on pathological evaluation of the explanted liver, with a pre-OLT workup showing a normal serum alpha-fetoprotein (AFP) level (<20 ng/mL) and/or no suspicious lesion on preoperative radiological evaluation. RESULTS: Nine patients had a tumor that met the criteria for an undetected HCC. The most common cause for transplantation was cryptogenic cirrhosis (44.4%). Tumor size was 2 cm or less in all patients, vascular invasion was detected in 11.1% of the patients, and tumor, node, metastasis (TNM) classification was stage I in 77.8%. Eight patients (88.9%) remained alive at the cessation of the analysis with a mean follow-up of 60 +/- 30.4 months. There was no tumor recurrence in any patient. Statistical analysis showed significant differences between undetected and detected HCCs when causes of pretransplantation liver disease, peak AFP level, tumor size, number of tumors, presence of vascular invasion or pathological differentiation were compared. Undetected HCCs were associated with a better survival rate after liver transplantation (p = 0.008). CONCLUSIONS: Patients with undetected HCCs at OLT have a favorable outcome with tumor-free survival. Most patients had small, early-stage HCCs, but the possibility of finding tumors greater than 2 cm, multifocal lesions, and vascular invasion exist despite thorough investigation. An exhaustive histopathological search of the explant for malignancy will allow for greater accuracy in prognosis.     

En bloc resection for primary non-Hodgkin's lymphoma of the descending colon with massive extension into the neighboring organs

A 79-year-old female who was surgically treated and received adjuvant chemotherapy for primary non-Hodgkin's lymphoma of the descending colon with massive extension into the pancreatic tail, spleen, and left kidney is herein reported. The patient had acute colonic obstruction and an urgent laparotomy was performed because endoscopic decompression using a transnasal ileus tube could not be done. We performed a left colectomy with an en bloc resection of the neighboring organs, followed by the creation of an end colostomy. The patient had no major postoperative complications and is well without any recurrence of lymphomas 6 months after surgery.     

Hepatopancreatoduodenectomy could be allowed for patients with advanced intrahepatic cholangiocarcinoma

BACKGROUND/AIMS: Patients with advanced intrahepatic cholangiocarcinoma (ICC) have a poor outcome even if they undergo extended radical surgery. Hepatopancreatoduodenectomy (HPD; hepatectomy with pancreatoduodenectomy) for ICCs may be expected to provide a favorable outcome if curative resection is reasonable and patients can tolerate the radical major procedure. METHODOLOGY: Between January 1981 and March 2002, 152 hepatic resections were performed for ICC. Of these, 12 patients underwent HPD for ICC at the same institute of Gastroenterology, Tokyo Women's Medical University. HPD for ICC was indicated in patients who (1) require dissection of the peripancreatic lymph nodes, (2) exhibit direct invasion of intrapancreatic bile duct, (3) show signs of intrapancreatic bile ductal growth. RESULTS: Characteristics of the short-term survivors (died within 12 months), compared with long-term survivors (survived more than 12 months), indicated that they were more likely to be positive intrahepatic metastasis, to be positive lymph node metastasis, to be positive portal venous invasion, and margins of resected surface with residual tumor. The actuarial overall 1-, 3-, 5-, 10-year survival rates were 42%, 33%, 33%, and 23%, respectively. The 5-year survival rate in patients without lymph node metastasis was significantly better (p = 0.045) than that of patients with lymph node metastasis. The patients who underwent potentially curative resection had significantly better 5-year survival rates than those who underwent non-curative resection. Four patients survived for at least 5 years and two of these patients survived for more than 10 years. Nine patients developed recurrence after resection, and of these, 5 patients with recurrence died within 12 months after surgery. CONCLUSIONS: HPD is considered to be an efficacious procedure for advanced ICC and long-term survival may be possible in a selected group of patients.     

The efficacy of measurement of the serum beta-d glucan in the patients with biliary atresia

Background

The pediatric end-stage liver disease (PELD) score is not a direct index that reflects the degree of hepatocellular injury. Beta-d glucan (BDG) in the portal vein blood is processed by the hepatic reticuloendothelial system. It is possible that the hepatic clearance of BDG may be used as a biological index to assess the liver function. In this study, the relationship between PELD score and hepatic clearance of BDG was made clear in order to study the efficacy of measurement of the serum BDG.

Methods

This study including 21 patients with biliary atresia (BA) who underwent liver transplantation (LT) was performed. The BDG was measured in the preoperative peripheral vein blood and the portal vein blood at the time of LT.

Results

The portal vein blood showed a significantly high level of BDG than the peripheral vein blood (p?<?0.01). There was a significant negative correlation between the PELD score and the hepatic clearance of BDG in the 10 patients who were indicated for LT due to liver failure (p?<?0.01).

Conclusion

The serum BDG can be used as a biological index in place of liver metabolism and should be measured in BA patients as a non-invasive indicator of the degree of progression of liver failure.     

Health‐related quality of life in parents of pediatric solid organ transplant recipients in Japan

Few studies have examined HRQOL in pediatric Tx recipients’ parents. This study investigated HRQOL in these parents and relationships between HRQOL and perceived burden of nurturing, family functioning, and social support. Self‐report anonymous questionnaires and a survey of medical records were completed between September and December 2013. The SF‐36v2, which evaluates physical, psychological, and social health, was used to measure HRQOL. While values for physical and psychological health were higher than standard values (Cohen's d = 0.34 and 0.17, respectively), social health scores were lower (d = 0.21). “Parental consultation unrelated to donation” (standardized partial regression coefficient: β = ?0.52) was associated with physical health. “Family functioning” and “Commuting time between home and primary follow‐up hospital” (β = 0.57 and ?0.31) were related to psychological health. “Total score for perceived burden of nurturing” (β = ?0.31) was related to social health. Regarding parental HRQOL, while physical and psychological health was favorable, social health was impaired. In clinical practice, interventions targeting parents’ physical conditions and facilitation of community and family understanding and support to share recipients’ nurturing are important in improving parental HRQOL.