Usefulness of laparoscopic subtotal cholecystectomy with operative cholangiography for severe cholecystitis

Purpose

Cholecystectomy can become hazardous when inflammation develops, leading to anatomical changes in Calot’s triangle. We attempted to study the safety and efficacy of laparoscopic subtotal cholecystectomy (LSC) to decrease the incidence of complications and the rate of conversion to open surgery.

Methods

Patients who underwent LSC between January 2005 and December 2008 were evaluated retrospectively. The operations were performed laparoscopically irrespective of the grade of inflammation estimated preoperatively. However, patients with severe inflammation of the gallbladder underwent LSC involving resection of the anterior wall of the gallbladder, removal of all stones and placement of an infrahepatic drainage tube. To prevent intraoperative complications, including bile duct injury, intraoperative cholangiography was performed.

Results

LSC was performed in 26 elective procedures among 26 patients (eight females, 18 males). The median patient age was 69 years (range 43–82 years). The median operative time was 125 min (range 60–215 min) and the median postoperative inpatient stay was 6 days (range 3–21 days). Cholangiography was performed during surgery in 24 patients. One patient underwent postoperative endoscopic sphincterotomy for a retained common bile duct stone that was found on cholangiography during surgery. Neither complications nor conversion to open surgery were encountered in this study.

Conclusions

LSC with the aid of intraoperative cholangiography is a safe and effective treatment for severe cholecystitis.     

Multifocal lesions with pancreatic atrophy in IgG4-related autoimmune pancreatitis: report of a case

We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases.     

Association between “loco-check” and EuroQol,a comprehensive instrument for assessing health-related quality of life: a study of the Japanese general population

Background The concept of “locomotive syndrome” (LS) was proposed by the Japanese Orthopaedic Association (JOA) in 2007 to refer to the risk of elderly individuals becoming bedridden because of reduced function of locomotive organs, for example muscles, bones, and joints. The purpose of this study was to clarify the association between LS screening results based on “loco-check” and health-related quality of life (HRQoL) assessed by use of EuroQol.Materials and methods Four-hundred and forty-two Japanese subjects (183 males and 259 females) were evaluated for LS and HRQoL by use of “loco-check,” EuroQol-5 dimensions (EQ-5D), and EuroQol-VAS (EQ-VAS). If the subjects answered “yes” to one or more of the seven items of “loco-check,” they were assigned to a locomotive syndrome suspected group (L group). If they answered “no” to all seven items, they were assigned to a locomotive syndrome not suspected group (NL group). We investigated the association between the screening LS results obtained by use of “loco-check” and HRQoL status determined by use of EQ-5D utility value and EQ-VAS score.Results LS was suspected among 39.6 % of the subjects on the basis of “loco-check.” In univariate analysis, significantly higher age, higher female-to-male ratio, and more reduced HRQoL were observed in the L group than in the NL group, according to EQ-5D and EQ-VAS. Logistic regression analysis showed that EQ-5D utility value and EQ-VAS score were associated with LS and the difference was statistically significant. Furthermore, correlations were found between the number of items with a “yes” answer on “loco-check”, EQ-5D, or EQ-VAS. That is, a larger number of items with a “yes” answer on “loco-check” was associated with reduced HRQoL assessed by use of EQ-5D and EQ-VAS.Conclusions We demonstrated that a finding of LS on the basis of “loco-check” is significantly associated with EQ-5D utility value and EQ-VAS score, and that a population identified as having LS by use of “loco-check” also had reduced HRQoL. Furthermore, it is speculated that the severity of reduced HRQoL because of locomotive dysfunction can be determined by use of “loco-check”.     

Critical neuroprotective roles of heme oxygenase‐1 induction against axonal injury‐induced retinal ganglion cell death

Although axonal damage induces significant retinal ganglion cell (RGC) death, small numbers of RGCs are able to survive up to 7 days after optic nerve crush (NC) injury. To develop new treatments, we set out to identify patterns of change in the gene expression of axonal damage‐resistant RGCs. To compensate for the low density of RGCs in the retina, we performed retrograde labeling of these cells with 4Di‐10ASP in adult mice and 7 days after NC purified the RGCs with fluorescence‐activated cell sorting. Gene expression in the cells was determined with a microarray, and the expression of Ho‐1 was determined with quantitative PCR (qPCR). Changes in protein expression were assessed with immunohistochemistry and immunoblotting. Additionally, the density of Fluoro‐gold‐labeled RGCs was counted in retinas from mice pretreated with CoPP, a potent HO‐1 inducer. The microarray and qPCR analyses showed increased expression of Ho‐1 in the post‐NC RGCs. Immunohistochemistry also showed that HO‐1‐positive cells were present in the ganglion cell layer (GCL), and cell counting showed that the proportion of HO‐1‐positive cells in the GCL rose significantly after NC. Seven days after NC, the number of RGCs in the CoPP‐treated mice was significantly higher than in the control mice. Combined pretreatment with SnPP, an HO‐1 inhibitor, suppressed the neuroprotective effect of CoPP. These results reflect changes in HO‐1 activity to RGCs that are a key part of RGC survival. Upregulation of HO‐1 signaling may therefore be a novel therapeutic strategy for glaucoma. © 2014 Wiley Periodicals, Inc.     

Mechanized assay of plasma prekallikrein by activation with Pseudomonas aeruginosa elastase and amidolysis of chromogenic substrate.

An automated assay of plasma prekallikrein is described. Prekallikrein was converted to kallikrein with Pseudomonas aeruginosa elastase, and the hydrolytic activity of kallikrein to H-D-Pro-Phe-Arg-paranitroanilide subsequently measured.

The conversion was complete within 8 minutes and the amidolytic activity remained stable at least another 10 min at 37 ° C. This method worked in plasma deficient in Hageman factor (blood coagulation factor XII). Using anti-prekallikrein antibody and plasma deficient in prekallikrein, the amidolytic activity generated in normal plasma was identified as due to kallikrein. With plasma samples, the coefficients of variation (CV) for multiple measurements within run (n = 10) and between run (n = 10) were as low as 5.0% and 6.6%, respectively, and the minimum measurable concentration of prekallikrein in plasma was 10% of the normal level.     

Self-Management of Infection Control Behavior of Adult Recipients of Living-Donor Liver Transplantation Within 5 Years After Transplantation

This study determines the present condition of self-management of infection control behavior of adult recipients who underwent living-donor liver transplantation (LDLT). The design was a qualitative study using a semistructured interview. The subjects were recipients who underwent LDLT at Kyoto University Hospital within 5 years to March 2011 and gave their consents to participate in this study. The subjects were 10 recipients (4 male and 6 female), and their average age was 56.7 years. Of 502 sentences about self-management behavior extracted from the verbatim records of all subjects, 61 sentences were about infection control behavior. Cluster analysis was used to classify these sentences into 5 groups: basic preventive behavior, application preventive behavior, active preventive behavior, change of preventive behavior depending on physical condition, and establishment of preventive behavior.