Pancreaticoduodenectomy for pancreatoblastoma: a case report and literature review

Pancreatoblastoma (PB) is extremely rare. A 11-year-old boy, who had excision of dilated common bile duct with hepaticoduodenostomy when 9 years old was referred to our institute for further management of abdominal pain and steatorrhea. Imaging studies showed a solid 4 cm tumor in the head of the pancreas and two lesions in the liver. Needle biopsies diagnosed PB with liver metastases. After five courses of chemotherapy, the primary tumor was completely resected with pancreaticoduodenectomy (PD) and Child’s pancreaticobiliary tract reconstruction. The liver metastases were resected. Postoperative recovery was uneventful. Here, we present this case and review the literature focusing on management of PB.     

A method for improving the light intensity distribution in dental light-curing units

A method for improving the uniformity of the radiation light from dental light-curing units (LCUs), and the effect on the polymerization of light-activated composite resin are investigated. Quartz-tungsten halogen, plasma-arc, and light-emitting diode LCUs were used, and additional optical elements such as a mixing tube and diffusing screen were employed to reduce the inhomogeneity of the radiation light. The distribution of the light intensity from the light guide tip was measured across the guide tip, as well as the distribution of the surface hardness of the light-activated resin emitted with the LCUs. Although the additional optical elements caused 13.2-25.9% attenuation of the light intensity, the uniformity of the light intensity of the LCUs was significantly improved in the modified LCUs, and the uniformity of the surface hardness of the resin was also improved. Our results indicate that the addition of optical elements to the LCU may be a simple and effective method for reducing inhomogeneity in radiation light from the LCUs.     

Esophageal atresia and tracheo-esophageal fistula associated with coarctation of the aorta,CHARGE association,and DiGeorge syndrome: a case report and literature review

CHARGE association and DiGeorge syndrome (DGS) rarely occur together and only eight cases have been reported in the English literature. Two were associated with esophageal atresia (EA) and severe congenital heart anomalies. We report a third case of EA with tracheoesophageal fistula (EA-TEF) associated with coarctation of the aorta (CoA), CHARGE association, and DGS. The challenge for management in this complicated case is the background DGS which influences surgical outcome because of Ca++ imbalance and immune deficiency that can be life-threatening and require bone marrow transplantation.     

Type-A long-gap esophageal atresia treated by thoracoscopic esophagoesophagostomy after sequential extrathoracic esophageal elongation (Kimura’s technique)

Introduction

We report four cases of long-gap esophageal atresia (LGEA) treated with thoracoscopic esophagoesophagostomy (TEE) after sequential extrathoracic esophageal elongation (SEEE: Kimura’s technique).

Methods

All initially had gastrostomy, then SEEE. The proximal end of the esophagus was introduced into the apex of the thorax under direct vision during TEE.

Results

Mean birth weight was 1.9 kg. Mean gestational age was 35.0 weeks (range 30–39); mean age at initial esophagostomy was 43.2 days (range 15–110); SEEE was performed for a mean of 3 times (range 2–4) at mean intervals of 5.3 months (range 2–10), with the upper esophageal segment lengthened by a mean of 2.1 cm each time (range 1.1–3.5). Mean age and weight at TEE were 22.3 months and 9.8 kg, respectively. Gap was initially 4.5 vertebrae (range 4–5). Mean operating time was 9.6 h. TEE was successful in 3; 1 required thoracotomy, then re-anastomosis after 11 months of anastomosis leakage; 2 cases with post-TEE anastomosis leakage were treated conservatively. Postoperatively, all cases required fundoplication and esophageal dilatation (2, 3, 5, 8 times, respectively). At mean follow-up of 3.6 years, 2 eat normally and 2 eat minced food.

Conclusions

TEE after SEEE appears to be a feasible option for treating LGEA.     

Effects of thermal cycling on dynamic viscoelastic properties of four commercial resins for crown and bridge

To elucidate the effects of thermal cycling on the viscoelastic properties of four commercial resins for crown and bridge, dynamic shear modulus (G'), mechanical loss tangent (tan delta), Knoop hardness, water sorption and appearance of specimen surfaces before and after thermal cycling test were determined. The changes of G' and tan delta for two materials were insignificant with increased repetitions of thermal cycling. Those of the other two materials were statistically significant: in particular, G' at temperatures above 60 degrees C was inclined to increase slightly and tan delta decreased considerably. While the Knoop hardness of the materials was a little decreased over a number of 75,000 thermal cycles, the water sorption almost attained an equilibrium in uptake after 14,000 thermal cycles. Furthermore, cracks on the specimen surface were observed after 37,500 to 75,000 thermal cycles. From these results, the deterioration of materials was observed as damage to the specimen surface. Moreover, it could be presumed that the materials would be further polymerized during the period of thermal cycling.     

Deformation and flexural properties of denture base polymer reinforced with glass fiber sheet

The purpose of this study was to investigate the deformation and flexural properties of acrylic and urethane polymers reinforced with glass fiber sheet. Four types of specimen--self-curing resin plate (R), light-curing oligomer plate containing a reinforcement (GO), and self-curing resin plate containing a reinforcement on one (GR) or both (GRG) sides--were prepared with three thicknesses: 1.5, 2.4, and 3.0 mm. Gaps between polymerized test specimen and a standard metal plate were measured at the corner (C), middle of the long sides (LS), and middle of the short sides (SS). The gaps for R were 0-2.0 microm. GO and GR markedly deformed at Points C, LS, and SS, and the degree of deformation increased as GO became thinner. Flexural strength was significantly increased by the reinforcement (p < 0.05). The flexural moduli of 3.0-mm thick R, GO, and GR were significantly smaller than that of 1.5-mm thick specimens.     

Response: BDNF as an anterophin; a novel neurotrophic relationship between brain neurons

New evidence supports the notion that BDNF can act in an anterograde direction in addition to the more well-known retrograde action where BDNF is released by the target cell and acts presynaptically.     

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO₂ was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.     

Spontaneous sutureless closure of the abdominal wall defect in gastroschisis using a commercial wound retractor system

Purpose  

We report our experience of using a commercial wound protector and retractor system to allow spontaneous sutureless closure of the abdominal wall defect in gastroschisis.