Inferior branch-preserving superior head resection of the pancreas with gastric wall-covering method for intraductal papillary mucinous adenoma

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas showed significantly less aggressive pathologic features compared with common pancreatic cancer. Therefore, several organ-preserving techniques, including duodenum-preserving pancreatic head resection, have been advocated in surgical procedures for IPMN. We describe a surgical technique of superior head resection of the pancreas with inferior branch preservation followed by a gastric wall-covering method for the prevention of pancreatic leakage in patients with IPMN of the pancreas head.     

Hypertension Cure Following Laparoscopic Adrenalectomy for Hyperaldosteronism is not Universal: Trends Over Two Decades

Background

Laparoscopic adrenalectomy has been established as a standard surgical method for unilateral primary aldosteronism. Meanwhile, the background characteristics of the patients undergoing adrenalectomy have changed over the last 20 years. The aim of this study was to investigate the changes in hypertension cure rates after laparoscopic adrenalectomy during the last two decades.

Methods

This retrospective clinical study included 176 patients who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism from 1995 to 2015. The patients were divided into two groups by decade. The patients’ baseline characteristics and the hypertension cure rates were compared between the two groups. Additionally, the values were re-examined based on predictive model predicting postoperative hypertension cure.

Results

The hypertension cure rate decreased significantly from 51.8 to 31.1%. The following variables were significantly different between the two groups: age, sex, body mass index, history of diabetes mellitus, preoperative systolic and diastolic blood pressures, potassium level, and plasma renin activity.

Conclusions

This study showed that the number of patients with unfavorable conditions for hypertension cure after adrenalectomy has recently increased. The treatment goal for primary aldosteronism is not only to cure the hypertension but also to prevent organ disorders due to inappropriate aldosterone levels. Therefore, we recommend laparoscopic adrenalectomy for unilateral primary aldosteronism, even if hypertension is not always cured postoperatively. However, clinicians need to fully explain the postoperative hypertension outcomes to primary aldosteronism patients.

     

Low energy dislocation of the hip joint in an adult with hereditary multiple exostosis

This article will describe the incidence of a low-energy hip dislocation, due to a fall from a standing height, in a 64-year-old female with hereditary multiple exostosis (HME). The dislocated left hip was reduced under spinal anesthesia, and the patient was restricted to 3 weeks of bed rest with skeletal traction of the affected limb. The post-reduction CT scan revealed a tangential fracture in the apex of the exostosis on the posteroinferior aspect of the femoral neck. The exostosis was assumed to impinge on the ischium and that the lever mechanism led to the dislocation. The 3 month follow-up MRI revealed no evidence of subluxation or avascular necrosis of the femoral head.     

Oral analgesia by non-steroidal anti-inflammatory drug zaltoprofen to manage cystoscopy-related pain: A prospective study

Objectives:   To examine the pre-emptive analgesic effect of the non-steroidal anti-inflammatory drug zaltoprofen against rigid cystoscopy-associated pain, and compare it with the effect of an anesthetic gel.
Methods:   Forty men periodically undergoing follow-up office cystoscopy were enrolled in this prospective study. The effects of lidocaine gel alone or in combination with zaltoprofen, were examined. The following parameters were assessed using an 11-point numerical rating scale: pain during injection of gel into the urethra, insertion of rigid cystoscope, and the endoscopic examination of the urinary bladder, pain at the first urination after cystoscopy, and at the first urination in the following morning at home.
Results:   Pain scores with pre-emptive zaltoprofen plus lidocaine gel were significantly lower than the ones with lidocaine gel alone at the time points of inserting rigid cystoscope into the urethra, viewing inside the urinary bladder and the first urination after cystoscopy. The efficacy of zaltoprofen was more significant in the patients with higher baseline pain score. There was no correlation between pain scores and bladder cancer grading, number of tumors, and time from surgery.
Conclusions:   Pre-emptive zaltoprofen is able to control cystoscopy-associated pain, which translates into better quality of life for patients. Thus, its use is recommended in the management of these patients.     

Influence of activity level on the outcome of treatment of lateral ankle ligament rupture

Background  Few studies of treatment of lateral ankle ligament rupture have given careful consideration to the activity levels of patients. In the present study, we investigated whether a patient’s activity level influences the outcome of the treatment of lateral ankle ligament rupture and whether treatment should be determined according to activity level. Methods  A total of 115 consecutive patients with lateral ankle ligament rupture were treated with short-term cast immobilization followed by functional bracing. We divided preinjury activity levels and activity levels at follow-up into four classes according to the International Knee Documentation Committee standards. Follow-up examination 1 year after injury included clinical assessment (anterior drawer test, range of motion, maximum circumference of the calf, tenderness, swelling), reinjury assessment, and functional evaluation by means of the Karlsson scoring system. Results  We found significant differences in ankle stability and reinjuries between the four groups classified by their preinjury activity level. The number of patients with ankle instability and reinjury was significantly higher in the high-activity group than in the low-activity groups. We also found significant difference between groups classified by activity level at follow-up with regard to the Karlsson score. Conclusions  The outcome of treatment of lateral ankle ligament rupture is significantly influenced by the patient activity level, and treatment may need to be determined according to this activity level.     

Pharmacological study of BRS, a new bicarbonated Ringer's solution, in partially hepatectomized rabbits

BACKGROUND AND OBJECTIVE: The effects of bicarbonated Ringer's solution were evaluated and compared with those of acetated Ringer's, lactated Ringer's and Ringer's solutions in partially hepatectomized rabbits. METHOD: Animals were randomly divided into six groups (n = 6 in each group): a sham-operated group, an operated group without infusion, and four operated groups with infusions of each of the four Ringer's solutions. Each Ringer's solution was intravenously administered at 40 mL kg(-1) h(-1) for 1.5 h. Arterial blood gases, plasma magnesium concentrations and cardiovascular parameters were analysed. RESULTS: The partial hepatectomy-induced decrement of base excess was inhibited by bicarbonated Ringer's solution more remarkably than by either lactated or plain solutions (P < 0.01). The alkalinizing effect of bicarbonated Ringer's solution tended to be more marked than that of the acetated solution but not significantly so. Plasma magnesium concentrations were well maintained by bicarbonated solution as compared to the other solutions (P < 0.01). CONCLUSIONS: These results suggest that bicarbonated Ringer's solution is the most suitable perioperative solution for metabolic acidosis and plasma electrolyte balance among the Ringer's solutions tested.     

The formation of wrinkles caused by transition of keratin intermediate filaments after repetitive UVB exposure

It has been reported that the formation of wrinkles involves changes in the elastic properties of the dermis due to the denaturation of elastic fibers. Several studies have shown that the hydration condition of the stratum corneum is also important in wrinkle formation. It is, however, still unclear how the stratum corneum contributes to wrinkle formation. Here we investigated the relationship between the formation of wrinkles and changes in the physical properties and condition of the skin after repetitive ultraviolet B (UVB) irradiation of hairless mice (HR/ICR). Repetitive UVB irradiation caused wrinkles on the dorsal skin of the mice. The elasticity (E) of the stratum corneum of UVB-irradiated mice was significantly lower than that of age-matched control (unirradiated) mice. UVB exposure also caused a deterioration of the fibrous ultrastructure of keratin intermediate filaments (KIFs) in the skin. We conclude that the deterioration of KIFs in the stratum corneum caused by repetitive UVB irradiation decreases the elastic properties of the stratum corneum, resulting in the formation of wrinkles.     

Morphological and optical properties of the corneal lens and retinal structure in the posterior large stemma of the tiger beetle larva

The morphological and optical features of the corneal lens and retina have been examined in the posterior large stemma of the larva of the tiger beetle (Cicindela chinensis). A cup-shaped retina was positioned 55+/-6microm beneath the posterior margin of the corneal lens, which was 479+/-20microm in diameter and 391+/-18microm in thickness (n=41). A light path through an isolated corneal lens showed that the object at infinite distance was focused on the distal margin of the retina. Geometrical optics gave a value of 334+/-15microm (n=55) for the posterior focal length of the corneal lens. The refractive index of the corneal lens was estimated to be around 1.8, if the lens was considered to be homogenous in structure. The internal structure of the lens, including concentric lamellae, was presumed to contribute to such a high refractive index, because this was higher than that of insect cuticle. The retinal structure and how images were blurred at different focus levels were also examined. Data obtained for optics of the corneal lens and retinal structures are discussed with reference to the distinct visual behavior of the larva.     

Increase in ovarian 15-hydroxyeicosatetraenoic acid during ovulation in the gonadotropin-primed immature rat

The ovarian level of 15-hydroxyeicosatetraenoic acid (15-HETE) was measured by RIA during ovulation in gonadotropin-primed immature Wistar rats. The ovulatory process was initiated in 25-day-old rats by a 10-IU injection of hCG sc 2 days after the animals had been primed with 10 IU PMSG, sc. Ovarian follicles begin to ovulate 10 h after hCG. At 0 h after hCG, the ovarian 15-HETE level was 0.6 +/- 0.2 ng/mg ovarian protein. At 6 h the 15-HETE level increased sharply to 27.3 +/- 4.2 ng/mg protein and reached a peak of 50.0 +/- 9.8 ng/mg protein at 10 h. Ovarian 15-HETE decreased significantly between 10-16 h after hCG (when ovulation was essentially completed). The pattern of secretion of this 15-lipoxygenase product was reciprocal to the pattern of secretion of leukotriene-B4 by the rat ovary. Ovarian 15-HETE production and ovulation were inhibited in a dose-dependent manner when indomethacin was administered sc 1 h after hCG in doses ranging from 0.10-10.0 mg/rat. In contrast, the synthesis of ovarian prostaglandins-E and -F was inhibited by a dose of indomethacin as low as 0.0316 mg/rat, but this dose did not significantly affect the ovarian 15-HETE level or the ovulation rate. Therefore, the ovulation rate was more closely correlated with the ovarian 15-HETE level (P less than 0.001) than with the ovarian levels of either prostaglandin-E or -F (0.10 greater than P greater than 0.05). The results suggest that products of the 15-lipoxygenase pathway of arachidonic acid metabolism may be important in the biochemical events of mammalian ovulation.