Esophagocardioplasty with gastric patch in the treatment of achalasia

Result of operative treatment in 196 cases of achalasia was reviewed. The procedures employed include cardiolysis, Heller's extramucosal myotomy, Wendel's cardioplasty, Heyrovsky's esophagocardiostomy, with and without pyloroplasty, cardiac resection and esophagocardioplasty with gastric patch. Follow-up study on 166 cases revealed that the result was classified as good in 99 cases or 59.6 per cent and improved in 46 cases or 27.7 per cent. Overall satisfactory result was obtained in 87.3 per cent. When the result was broken down to groups following three classifications, i. e. according to X-ray, endoscopic and manometric findings, the interesting correlation emerged. Heller's myotomy and esophagocardioplasty with gastric patch gave best results in early stage of achalasia, while in later stage the latter procedure seems to be the operation of choice.     

Contribution of whole body FDG-PET to the detection of distant metastasis in pancreatic cancer

OBJECTIVE: Accurate baseline staging is necessary to appropriately treat pancreatic cancer. The present study was undertaken to evaluate the clinical contribution of whole body FDG-PET to the detection of distant metastasis in pancreatic cancer. METHODS: A total of consecutive 42 patients with previously untreated pancreatic cancer were examined. Whole body FDG-PET imaging for initial staging was performed with a 3D acquisition and iterative reconstruction on Siemens ECAT HR+ scanner at 1 hour post 185-200 MBq 18F-FDG injection. PET findings were correlated with clinical and radiological data to determine the impact of PET on staging. RESULTS: In 16 patients, there were one or more sites of metastasis based on clinical data. FDG-PET correctly identified the presence of metastasis in 13 of 16 patients and its absence in 23 of the remaining 26 patients. Thus, FDG-PET missed 4 metastatic sites in 4 patients (liver and lung metastasis). FDG-PET correctly identified 8 metastatic sites in 7 patients (peritoneal dissemination and liver, bone and supraclavicular lymph node metastasis), which were missed on CT imaging. Based on whole body FDG-PET, the clinical stage was changed in 5 of 42 patients (11.9%). CONCLUSIONS: These results suggest that FDG-PET and CT appear to have a complementary role in the detection of distant metastasis in patients with pancreatic cancer.     

Report on the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America--analysis of radiation dose by a change of a scan parameter of multi-slice computed tomography by a film method

PURPOSE: It is for a purpose of this study to measure radiation dose by analyzing a dose profile of multi-slice computed tomography varying with helical pitch and a row slice thickness difference complicatedly. MATERIALS AND METHODS: We used multi-slice computed tomography, and helical pitch and row slice thickness change and scanned the helical scan. I used CTDI phantom of a diameter of 25 cm and I inserted roentgen diagnosis use film UR-2(new) which I put between my own phantom in center and 1 cm away from the outer surface and scanned it. And the provided level profile was converted into a dose profile with the dose-density curve which I made beforehand. I analyzed radiation dose than the dose profile. RESULT: In multi-slice computed tomography, radiation dose varied with assembly of row slice thickness and helical pitch. The change of a dose profile changed in a phantom surface part complicatedly. The maximum dose by the measurement of this time was 29 mGy in row slice thickness 0.5 mm, assembly of helical pitch 2.5. In addition, the minimum dose was 6.8 mGy in row slice thickness 3.0 mm, assembly of helical pitch 5.5. And, as for the difference of maximum dose in the same dose profile and the smallest dose, there were about 20 % in row slice thickness 1.0 mm, assembly of helical pitch 5.5. CONCLUSION: The dosimetry of multi-slice computed tomography by a film method enabled it to measure a change of a dose profile by a difference of a scan parameter by high interest solution ability. In addition, it is a method more superior in dosimetry of multi-slice computed tomography spreading through a Z-axis direction broadly than determination by computed tomography use ionization chamber dosimeter. Because radiation dose increases by a scan in thin row slice thickness and small helical pitch, care is necessary.     

Aortic root redissection associated with the use of gelatin-resorcin-formalin glue following surgical treatment for acute type A aortic dissection; report of a case

A late redissection case of the aortic root after total arch replacement for acute Stanford type A aortic dissection was reported. A 55-year-old male was treated with total arch replacement for acute Stanford type A aortic dissection. The aortic valve was bicuspid valve, and the right coronary leaflet was prolapsed because of the dissection of right and non coronary cusp. Resuspension of the commissure and the fixation of the dissected aortic wall with gelatin-resorcin-formalin (GRF) glue was performed during the operation. The initial postoperative course was uneventful and the patient discharged 52 days after the operation. Redissection of aortic root was pointed out on the computed tomography (CT) 3.5 years after the operation. As the second operation, the aortic root replacement was performed. Coronary artery bypass for right coronary artery was simultaneously performed with right internal thoracic artery because the right coronary ostium was stenotic and showed ischemic change on electrocardiogram monitor during the operation. The redissection was seen on the right coronary sinus, which was fixed by the GRF glue during the first operation. The pathological study showed the migration of macrophages and the tear of the fibrous tissue. These findings was thought to be associated with the use of the GRF glue. Careful use of the GRF glue for the fixation of the dissected aorta during the surgical treatment for the Stanford type A aortic dissection was thought to be important.     

Castleman's disease in the interlobar fissure resected by video-assisted thoracoscopic surgery; report of a case

An abnormal shadow was detected on the chest X-ray of a 33-year-old man in a medical check-up. Chest computed tomography (CT) showed a 2 x 2 x 3 cm tumor which was enhanced, round, homogeneous, and adjacent to the pulmonary artery in the right interlobar fissure. Video-assisted thoracoscopic surgery was performed in August 2002 for diagnosis and treatment. The tumor was surgically removed and grossly round, elastic and hard. The histopathological diagnosis was hyaline vascular type of Castleman's disease. Postoperative course was uneventful, and the patient was discharged on the third postoperative day. Interlobar Castleman's disease successfully resected by video-assisted thoracoscopic surgery is rare.     

Sharing of the same embryogenic pathway in anorectal malformations and anterior sacral myelomeningocele formation

The objective of this study was to determine whether anorectal malformations (ARMs) and anterior sacral myelomeningocele share the same embryogenic pathway in a mouse model. Etretinate (Ro 10-9359) was administrated to C57BL/6 mice on gestation day 9 (E9). Sections of embryos and fetuses from E9.5 to E18 were observed by HE staining. Immunohistochemical staining with anti-NeuN and anti-GFAP was also done to determine cell origins of a presacral mass. In etretinate-treated embryos, neuroepithelial cells proliferated in the presacral region on E9.5. On E12, a canal appeared between the ectopic proliferated neuroepithelium and hindgut. On E13, anorectum abnormally kept a canal with the ventral urogenital tract through a fistula. On E13.5, a huge mass formed in the presacral region. On E18, 76.9% (30/39) of fetuses had ARMs, 100% (39/39) had a presacral mass (71.8% were huge) and 100% (39/39) had a sacral defect. The types of ARMs were mainly rectourethral or rectocloacal fistula. The presacral mass was anterior sacral myelomeningocele. We thus established the first mouse model of the Currarino triad, congenital caudal anomalies, including ARM, sacral abnormality and presacral mass. These disorders share the same embryogenic pathway. The teratogenic target of etretinate is the tail bud. Abnormal differentiation of the tail bud mesenchyme leads to defects of the tailgut and caudal neural tube. The abnormal mass blocks normal descent of the dorsal cloaca through the most posterior part of the cloacal plate.     

The effects of dietary vitamin B12 deficiency on sperm maturation in developing and growing male rats

ABSTRACT  To evaluate the role of vitamin B₁₂ on spermatogenesis, the effects of dietary vitamin B₁₂ deficiency on sperm maturation in developing rat fetuses and young growing rats were examined. The vitamin B₁₂-defi-cient diet was given to all the animals for three different periods: whole period (gestation to mature), gestation period (gestation to weaning), or immature period (3–12 weeks postnatal). Sperm examination revealed that the sperm count was markedly lower in male progeny (F1) that were vitamin B₁₂-deficient during the whole period. In addition, a significantly higher number of abnormal sperm, such as tailless and amorphous sperm, was observed. In male rats that were vitamin B₁₂-deficient during the immature period, the incidence of abnormal sperms was 14.4% and 4.8% for tailless and short tail, respectively. The motion rates, such as path velocity and straight line velocity, were decreased to 20–40% of the control value in rats that were vitamin B₁₂-deficient both during the whole and gestation periods. However, no effects of vitamin B₁₂ deficiency on sperm motility were observed during the immature and mature periods. From these findings, we suggest that dietary vitamin B₁₂ deficiency during pregnancy may induce irreversible damage in the germ cells of embryos and affect the maturation of spermatozoa.     

Accuracy of flow and sensors of indirect calorimetry for neonates and infants: using mass spectrometry and a pneumotachogram

1. The accuracy of measurements of flow rate and concentrations of O2 and CO2 in expiratory gas by indirect calorimetry (IC) using paediatric and adult circuits were assessed by mass spectrometry and a pneumotachogram, which have been proven as the most reliable instruments for these purposes. 2. In the paediatric circuit, all measurements were demonstrated to be reliable: error rates for flow rate, O2 concentration and CO2 concentration were +3.13, +2.66 and -6.63%, respectively. All were within the 10%, which is acceptable as a biological error. 3. However, in the adult circuit of IC, all measurements were reliable except for measurements of CO2 concentration: error rates for flow rate, O2 concentration and CO2 concentration were +2.82, +1.64 and +11.42%, respectively. 4. A fluctuation phenomenon of expiratory gas concentration was observed only in IC. Mass spectrometry did not show this phenomenon. This phenomenon seems to be derived from the IC machine itself.     

Characterization of Klebsiella pneumoniae and Escherichia coli strains that produce CTX-M-2-type broad spectrum beta-lactamase isolated from a child with leukemia

An 8-year-old girl with acute leukemia had bacteremia caused by Klebsiella pneumoniae producing CTX-M-2-type broad spectrum beta-lactamase. K. pneumoniae and Escherichia coli strains producing the same enzyme and harboring identical conjugative plasmids were recovered from stoor culture. Patients with frequent episodes of neutropenia and prophylactic administration of beta-lactams are at risk of harboring colonizing strains that produce broad spectrum beta-lactamases.     

99mTc galactosyl human serum albumin liver dynamic SPET for pre-operative assessment of hepatectomy in relation to percutaneous transhepatic portal embolization

We have devised an original predictive residual index (PRI) using 99mTc diethylenetriaminepentaacetic acid galactosyl human serum albumin (99mTc-GSA) liver dynamic SPET for the pre-operative assessment of hepatectomy, including the prediction of residual liver function before hepatectomy. The aim of this study was to evaluate the usefulness of the PRI by using 99mTc-GSA liver dynamic SPET before and after percutaneous transhepatic portal embolization (PTPE) to induce compensatory hypertrophy of the remnant lobe, and to compare the results with the prognosis after hepatectomy. The subjects included eight patients with cholangiocellular carcinoma, five with gallbladder cancer, four with hepatocellular carcinoma and three with metastatic liver cancer. 99mTc-GSA liver dynamic SPET was performed immediately before and 2 weeks after PTPE. Dynamic SPET with 35 continuous rotations was performed to obtain the k-value according to the accumulation curve in each voxel (0.54 cm x 0.54 cm x 1.08 cm) of the liver immediately after a bolus injection of 185 MBq 99mTc-GSA. Each rotation consisted of 180 degrees turn in 64 steps in a 64 x 64 matrix. The acquisition time of each rotation was 35 s. We devised an original PRI by combining the k-value with functional liver volume which were measured by liver dynamic SPET. Hepatectomy was performed following the second SPET. The correlation between the PRI and post-operative patient prognosis was investigated retrospectively. The functional liver volume of the remnant lobe and the PRI significantly increased after PTPE compared with respective values before PTPE (P<0.005 and P<0.0001, respectively). Regarding the relationship between the PRI and the clinical course following surgery, post-operative complications were observed in only two patients. The PRI values of these two patients were 0.323 and 0.394. When the PRI was above 0.400, no patient had symptoms of hepatic failure. The results of this study suggest that, when the PRI value is above 0.400, there is a low probability of hepatic failure after hepatectomy. We conclude that the PRI devised in this study is useful in the pre-operative assessment of hepatectomy after PTPE.