Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy

Background/Purpose

It is generally thought that an internal short stent placed across the pancreaticojejunostomy (PJ) following pancreatoduodenectomy (PD) usually passes spontaneously through the rectum thereafter; however, we experienced some patients who presented with pancreatitis and cholangitis owing to delayed defecation of the stent. The purpose of this study was to clarify when the stent eventually became detached from the PJ and how it passed through the body until it was finally defecated. In addition, we also investigated the factors that may prevent such detachment and defecation.

Methods

This study retrospectively analyzed 57 patients who had had internal short stents placed across the PJ following PD. Defecation from the body, detachment from the PJ, and distal migration of the stent was confirmed by X-ray or computed tomography (CT) during the postoperative course. The cumulative rates of defecation and detachment of the stents, complications in relation to delayed defecation of the stents, and factors predictive of the delayed defecation, delayed detachment, and distal migration of the stents were analyzed.

Results

Defecation of the stent was confirmed in 35 patients. The median time to defecation after PD and the cumulative defecation rate at 1?year were 454?days and 41?%, respectively. Acute pancreatitis occurred in 2 patients with the stent remaining in the pancreatic duct. One patient experienced acute cholangitis owing to migration of the stent to the bile duct. Multivariate analysis showed that ≥5 stitches in the duct-to-mucosa anastomosis, stent size of ≥5?Fr, and pancreatic fistula classified as either Grade B or C were independent predictive factors for delayed defecation of the stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed detachment of the stent. A stent size of ≥5?Fr was a risk factor for distal migration of the stent.

Conclusion

In more than half of the study patients, internal short stents were not defecated within 1?year. Retrieval of the stent should be considered following the migration of an internal short stent. A stent size of ≥5?Fr was an independent predictive factor for delayed defecation and distal migration of a stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed defecation and detachment of a stent.     

Morphometric and immunohistochemical study of cholangiolocellular carcinoma: comparison with non-neoplastic cholangiole, interlobular duct and septal duct

Background/purpose

The origin of cholangiolocellular carcinoma (CoCC) is still controversial. To solve this problem, morphometric and immunohistochemical features of CoCC were examined.

Materials and methods

Cancerous ducts: 15 CoCC lesions from 13 resected and two autopsied cases. Non-neoplastic ducts: 20 specimens of non-cancerous areas of eight resected CoCC cases and of 12 resected hepatocellular carcinoma (HCC) cases. From these specimens, cholangioles, interlobular ducts of small size (ILD-S), interlobular ducts of medium size (ILD-M) and septal ducts were randomly selected.

Morphometry

The outer and inner diameters of these ducts were measured. Immunohistochemistry: two hepatocyte markers [Hep Par 1 and ??-fetoptotein (AFP)], two cholangiocyte markers (cytokeratin CK7, CK19), a marker for mucin (Muc1), a hepatic stem/progenitor cell marker (c-Kit) and epithelial membrane antigen (EMA) were used.

Results

Morphometry: both mean values of the outer and inner diameters of CoCC were far larger than those of cholangioles, and showed intermediate values between those of ILD-S and ILD-M. Immunohistochemistry: all ducts of CoCCs were negative for the two hepatocyte markers and positive for CK 7. Most CoCC ducts were positive for CK 19. Positive rate of c-Kit of cholangiole was most remote from that of CoCC. The positive rates of EMA in the membranous area of ducts were similarly very high in CoCC, cholangiole and ILD-S.

Conclusion

These results suggest that CoCCs may originate from ILDs.     

Nuclear hypersegmentation precedes the increase in blood eosinophils in acute eosinophilic pneumonia

In this case of acute eosinophilic pneumonia (AEP), eosinophils with hypersegmented nuclei emerged in the blood before the increase of eosinophil count. An 18-year-old woman complaining of fever, cough and dyspnea was admitted because of diffuse ground-glass opacities in her chest roentgenogram. On admission, her blood cell count revealed a marked increase of neutrophils. Although the number of eosinophils was normal, some of them contained three- or four-lobed nuclei. She was diagnosed to have AEP through bronchoalveolar lavage and transbronchial lung biopsy. The combination with acute clinical course, pulmonary infiltration and the presence of hypersegmented eosinophils in blood may imply the diagnosis of AEP.     

Dopamine receptors and dopamine-sensitive adenylate cyclase in canine caudate nucleus. Characterization and solubilization

The activities of dopamine-sensitive adenylate cyclase and [³H] dopamine binding showed a similar subcellular distribution in the canine caudate nucleus, and were present primarily in the synaptic membrane fractions. Binding of [³H]dopamine to the crude synaptic membranes was rapid, saturable and reversible in the presence of 2 mM ATP with a rate constant of 2.5 × 10⁵ M^?1 min^?1 and 0.63 min^?1for the forward and reverse reactions respectively. The equilibrium dissociation constant (K_d) for the binding was about 1.5 μM, almost identical to the K_a of adenylate cyclase for dopamine to stimulate half-maximally. Binding of [³H]dopamine in the absence of ATP exhibited a negative cooperativity, with two K_d values (0.11 μM and 8.1 μM), which was abolished by addition of 2 mM ATP. The major role of ATP appears to enhance the association of [³H]dopamine to the membranes. [³H]Dopamine binding in the presence of 2 mM ATP and dopamine-sensitive adenylate cyclase in the membranes were affected in a similar manner by catecholamines, some antidepressants and a variety of neuroleptics, with the exception of some phenothiazine derivatives such as chlorpromazine and fluphenazine. Propranolol and cocaine, an uptake inhibitor at neuronal membranes, did not inhibit either activity. Dopamine sensitivity of the pariculate adenylate cyclase tended to be increased by the addition of 0.001% Lubrol PX in the incubation but was greatly impaired by more than 0.005% Lubrol PX. The synaptic membranes were solubilized with 2% Lubrol PX in the presence of NaF from the particulate fractions. This solubilization procedure preserved well not only fluoride sensitivity but also dopamine responsiveness of adenylate cyclase in the supernatant fluid.     

Effective hormone therapy of prostatic cancer with lung metastasis: 2 cases

Many prostatic cancer patients have local symptoms such as dysuria and hematuria, but relatively few are seen with lung metastasis. This time we experienced 2 cases of prostatic cancer with a lung metastasis focus as the first symptom. Administration of diethylstilbestrol 500 mg/day for 20 days produced marked effects; reduction or disappearance of the lung metastasis focus, noticeable reduction of prostatic tumor and the improvement of their total condition. The literature is also reviewed.     

Effect of a new potent H2-receptor antagonist 3[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]-N2-sulfamoylpropionamidine (YM-11170) on gastric mucosal histamine-sensitive adenylate cyclase from guinea pig

The effect of 3[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]-N²-sulfamoylpro-pionamidine (YM-11170), a new thiazole H₂-receptor antagonist bearing propionamidine at the terminus of a side chain, on histamine-sensitive adenylate cyclase [ATP pyrophosphate-lyase (cyclizing); EC 4.6.1.1] of gastric mucosa from the guinea pig was studied and compared with that of cimetidine. YM-11170 displaced the concentration-stimulation curve of histamine-sensitive adenylate cyclase to the right with a pA₂ of 7.65 (K_i, = 2.25 × 10^?8M). Stimulation of gastric adenylate cyclase by 0.1 mM histamine was competitively inhibited by YM-11170 and cimetidine in a dose-dependent manner, with ic₅₀ values of 5.9 × 10^?7M and 1.4 × 10^?5M respectively. Hippocampal histamine-sensitive adenylate cyclase in the presence of 0.1 mM histamine was also competitively inhibited by YM-11170 with an ic₅₀ of 1.1 × 10^?7 M. YM-11170 did not affect Gpp(NH)p-, NaF-, PGE₂-stimulated or basal activity of the gastric adenylate cyclase. These data, together with other results, indicate that YM-11170 is a highly selective and potent H₂-receptor antagonist which competes with histamine at the receptor site on the histamine-sensitive adenylate cyclase.