Comparative study of anastomosis in pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy

BACKGROUND/AIMS: The relative advantages of pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy remain to be established. To clarify differences between the two procedures, we examined 66 patients who underwent PD and compared clinical and histological parameters, surgical records and patient outcomes. METHODOLOGY: In this retrospective study, subjects were divided into a pancreaticojejunostomy group (n=48) and a pancreaticogastrostomy group (n=18). Pancreaticogastrostomy and pancreaticojejunostomy were performed using invagination technique and end-to-side anastomosis, respectively. RESULTS: There were no significant differences in patient demographics and surgical records between the two groups. Increases in serum amylase concentrations after operation were significantly greater in the pancreaticogastrostomy group (902 +/- 915 IU/L) than in the pancreaticojejunostomy group (326 +/- 761 IU/L) (p = 0.025). However, there were no significant differences in other postoperative laboratory data or complications between the two groups. CONCLUSIONS: In our study, the clinical and safety data associated with pancreaticojejunostomy and pancreaticogastrostomy procedures for anastomosis after pancreaticoduodenectomy were almost similar. Therefore, the anastomotic procedure used should depend on the surgeon's choice or the distance between the remnant stomach and pancreas.     

Hyperbaric oxygen therapy for the treatment of postoperative paralytic ileus and adhesive intestinal obstruction associated with abdominal surgery: experience with 626 patients

BACKGROUND/AIMS: The results of hyperbaric oxygen (HBO) therapy for treatment of postoperative paralytic ileus and adhesive intestinal obstruction associated with abdominal surgery are unknown. METHODOLOGY: A retrospective review of postoperative paralytic ileus and adhesive intestinal obstruction associated with abdominal surgery in 626 patients required 758 admissions who underwent HBO therapy was undertaken to examine the efficacy of HBO therapy. RESULTS: The overall resolution rates for patients receiving HBO therapy in cases of postoperative paralytic ileus and adhesive intestinal obstruction were 92% and 85%, respectively. Among patients who were more than 75 years old, the therapies resolved 35 (97%) of 36 cases of postoperative paralytic ileus and 42 (81%) of 52 cases of adhesive intestinal obstruction, which was comparable to the results for patients less than 75 years old. The mortality rate was 1.2% overall. Complications related to HBO therapy occurred in 3.8% of the admissions, and most of them were not serious. CONCLUSIONS: These results suggest that HBO therapy might deserve further assessment for use in management of postoperative paralytic ileus and adhesive intestinal obstruction as a new modality. HBO therapy is safe and non-invasive, and may be useful in the elderly patients, since mortality was relatively low in this series.     

Galactolipid synthesis in chloroplast inner envelope is essential for proper thylakoid biogenesis, photosynthesis, and embryogenesis

The biogenesis of thylakoid membranes, an indispensable event for the photoautotrophic growth of plants, requires a significant increase in the level of the unique thylakoid membrane lipid monogalactosyldiacylglycerol (MGDG), which constitutes the bulk of membrane lipids in chloroplasts. The final step in MGDG biosynthesis occurs in the plastid envelope and is catalyzed by MGDG synthase. Here we report the identification and characterization of an Arabidopsis mutant showing a complete defect in MGDG synthase 1. The mutant seeds germinated as small albinos only in the presence of sucrose. The seedlings lacked galactolipids and had disrupted photosynthetic membranes, leading to the complete impairment of photosynthetic ability and photoautotrophic growth. Moreover, invagination of the inner envelope, which is not seen in mature WT chloroplasts, was observed in the mutant, supporting an old hypothesis that envelope invagination is a major event in early chloroplast biogenesis. In addition to the defective seedling phenotype, embryo development was arrested in the mutant, although seeds with impaired embryos could germinate heterotrophically. These results demonstrate the importance of galactolipids not only in photosynthetic growth but also in embryogenesis.     

Late fatal recurrence in gefitinib-treated NSCLC patients

Gefitinib is a selective epidermal growth factor receptor tyrosine kinase inhibitor, which blocks signal transduction pathways implicated in proliferation and survival of cancer cells. Long-term survival in patients with metastatic non-small-cell lung carcinoma (NSCLC) treated with gefitinib has recently been reported. We showed herein two cases of fatal rapid recurrence after a long-term disease control by gefitinib. The biology of fatal aggressive recurrence of gefitinib-treated NSCLC is not well characterized. Regardless of the mechanism, however, physicians treating patients with gefitinib should be alert to the possibility of fatal rapid recurrence after a long-term disease control by this drug.     

Lower birth weight is associated with higher resting heart rate during boyhood.

There is substantial evidence that low birth weight is associated with the development of cardiovascular disease in adult life. Moreover, resting heart rate is a prognostic factor of cardiovascular morbidity and mortality. However, there are scarce data regarding the association between birth weight and resting heart rate in later life. Therefore, we investigated the association of anthropometric data at birth and hemodynamic indices including resting heart rate in Japanese boys. The data of 1,107 male students of a junior high school in Tokyo, Japan, who underwent a medical check-up in the year of admission to the school (12 or 13 years old) were used. Information on anthropometric data at birth based on "The Maternal and Child Health Handbook" was obtained from 573 students. From a standard 12-channel resting electrocardiogram, 8 cardiac cycles were used to estimate heart rate. Resting heart rate correlated positively with body mass index at the same age (r=0.100, p=0.017) and correlated negatively with birth weight (r=-0.102, p=0.015), height at birth (r=-0.125, p=0.003), and head circumference at birth (r=-0.095, p=0.025). The negative correlation of anthropometric data at birth with heart rate at the age of 12 or 13 was independent of body mass index at the same age. The mean value of resting heart rate at the age of 12 or 13 adjusted for body mass index at the same age was significantly higher in the lower tertile of birth weight than in the higher tertile of birth weight (81.7 vs. 78.5 beats/min, p=0.028). In conclusion, lower birth weight is associated with higher resting heart rate during boyhood, suggesting that elevated heart rate may be one mechanism linking small size at birth with the development of cardiovascular disease in future life.     

Successful treatment of a patient with primary Sjögren's syndrome complicated with pericarditis during pregnancy

A 35-year-old woman with primary Sj?gren's syndrome (pSS) developed fever and chest pain during pregnancy. When the dose of prednisolone was reduced, she experienced chest pain with elevated CRP and D-dimer, resulting in admission to our hospital with marked cardiomegaly and pleural effusion. Because there was no evidence of other autoimmune disorders or infection, oral prednisolone was increased to 30 mg daily with heparin, and hypercoagulopathy was carefully monitored. The patient's condition improved rapidly, and she delivered a healthy baby. This is the first case to support the beneficial effect of prednisolone in pericarditis with pSS, and illustrates its safety during pregnancy.     

Acute coronary syndrome due to coronary thrombus formed by severe coronary spasm: a case report

A 47-year-old man was admitted to our hospital complaining of chest pain at rest in the early morning. Electrocardiography showed ST segment elevation in leads II, III and aVF. Emergency coronary angiography revealed total occlusion of the right coronary artery at the proximal portion. Intracoronary administration of isosorbide dinitrate successfully recanalized the right coronary artery. However, there was a thrombus image at the culprit lesion. Intracoronary administration of urokinase caused the residual thrombus to disappear completely. Follow-up coronary angiography at 1 week and 3 months revealed no organic stenotic lesion. Intravascular ultrasound showed only a little plaque without signs of ruptured plaque in the right coronary artery. Provocation coronary angiography revealed remarkable spasm causing total occlusion at the proximal portion of the right coronary artery. This case suggests that only severe coronary spasm without plaque rupture could form a thrombus causing acute coronary syndrome.