Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose

Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated.

Methods

After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct.

Results

ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far.

Conclusions

ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case

A fistula between the aorta and the digestive tract is a rare complication of gastrointestinal tract or vascular surgery. There are occasional reports of aortoesophageal fistula as a fatal complication after esophagectomy or esophageal stent implantation and of aortoenteric fistula (AEF) as a complication after aortic or other vascular procedures. However, AEF after gastrointestinal surgery is rare. We report a case of AEF after laparoscopic total gastrectomy for advanced gastric cancer, using the so-called overlap method of esophagojejunal anastomosis. The patient was a 77-year-old Japanese woman who underwent laparoscopic total gastrectomy and esophagojejunal anastomosis with Roux-en-Y reconstruction for advanced gastric cancer. Bacterial peritonitis was diagnosed 5 days after the operation, manifesting as partial necrosis and perforation of the small intestine. The patient was treated successfully with laparoscopic partial resection of the small intestine, but ultimately died of massive hematemesis caused by the AEF 30 days after her primary surgery.     

Sarcopenia in patients with rheumatic musculoskeletal diseases

Aim

To investigate the impact of high-dose glucocorticoid therapy on sarcopenia in hospitalized patients with rheumatic musculoskeletal diseases (RMDs).

Methods

We included patients with RMDs who were hospitalized between 2020 and 2022 for remission induction treatment and collected information on skeletal mass index (SMI) before high-dose glucocorticoid therapy and 1 month later. We divided the patients into 2 groups according to the progression of sarcopenia, defined as a >10% decrease in SMI, and compared their clinical characteristics.

Results

Forty-nine patients were included in this analysis. The mean age was 53.3 years, 73.5% were female, and the mean SMI was 5.3 kg/m². Before treatment, 83.7% had already met the definition of sarcopenia, and 57.1% experienced further sarcopenia progression after 1 month of high-dose glucocorticoid treatment. Patients with sarcopenia progression were predominantly male (P = 0.025), had a higher body weight (P = 0.048), and showed a higher SMI than those without sarcopenia at baseline (P = 0.008). Multivariable analysis revealed that body weight increase from 0 to week 1 of high-dose glucocorticoid treatment was associated with sarcopenia progression (odds ratio: 0.22, 95% CI: 0.04–0.61, P = 0.007) with a cut-off of −1.8 kg. During a mean observation period of 30.2 days, the incidence of infection was significantly higher in patients with progressive sarcopenia (P = 0.042).

Conclusions

One-month hospitalization with high-dose glucocorticoid therapy is associated with sarcopenia progression in patients with RMDs. An early decrease in body weight can be used to predict muscle volume loss.     

Daytime Napping Benefits Passing Performance and Scanning Activity in Elite Soccer Players

The present study explored the effect of a daytime napping opportunity on scanning activity, which is an essential component of successful soccer performance. Fourteen male elite collegiate soccer players performed the Trail Making Test (TMT), which was used to assess complex visual attention. In addition, a soccer passing test, modified with reference to the Loughborough Soccer Passing Test, was used to evaluate passing performance as well as scanning activity. A cross-over design was applied to examine nap and no-nap interventions. Participants (N = 14, mean age: 21.6 SD = 0.5 years, height: 1.73 ± 0.06 m, body mass: 67.1 ± 4.5 kg) were randomly allocated to a midday nap (40 minutes) or no-nap group. Subjective sleepiness was measured using the Karolinska Sleepiness Scale, and perceptive fatigue was evaluated by the visual analog scale. There were no significant differences in subjective measurements or TMT between the nap and no-nap groups. However, the performance time for the passing test and scanning activity was significantly shorter (p < 0.001) and scanning activity was significantly more frequent in the nap condition than in the no-nap condition (p < 0.00005). These results suggest that daytime napping is beneficial for soccer-related cognitive function, represented by visuospatial processing and decision-making, and particularly as a potential countermeasure to mental fatigue. Considering that inadequate sleep and residual fatigue are commonly observed in elite soccer, this finding may have practical implications for the preparation of players. Key points

• The effect of daytime napping on passing performance, complex visual attention and scanning activity of elite collegiate soccer players were examined.
• The speed of passing and scanning activity was significantly shorter in the nap condition than in the no-nap condition.
• Scanning activity was significantly more frequent in the nap condition than in the no-nap condition.
• Daytime napping is likely to benefit soccer-related cognitive function, represented by visuospatial processing and decision-making.

Key words: Nap, fatigue, sports, soccer, performance, scanning activity     

Cholinergic Involvement and Synaptic Dynamin 1 Expression in Yokukansan‐mediated Improvement of Spatial Memory in a Rat Model of Early Alzheimer's Disease

The aim of this study was to investigate the effect of Yokukansan (YKS) on the impairment of spatial memory and cholinergic involvement in a rat model of early‐phase Alzheimer's disease (AD). In this model, rats underwent four‐vessel transient cerebral ischemia and then were treated with beta amyloid oligomers injected intracerebroventricularly once daily for 7 days. These animals showed memory impairment in an eight‐arm radial maze task without histological evidence of apoptosis but with a decrease in expression of hippocampal dynamin 1, an important factor in synaptic vesicle endocytosis. Oral administration of YKS for 2 weeks significantly increased the number of correct choices and decreased the number of error choices in the eight‐arm radial maze task (P < 0.05). Moreover, YKS significantly increased high K⁺‐evoked potentiation of acetylcholine (ACh) release (P < 0.05) and significantly increased the expression of dynamin 1 (P < 0.01) in the hippocampus. The ameliorative effect of YKS on spatial memory impairment in our rat model of early‐phase AD may be mediated in part by an increase in ACh release and modulation of dynamin 1 expression, leading to improved synaptic function. Future studies will determine whether YKS is similarly useful in the treatment of memory defects in patients diagnosed with early‐stage AD. Copyright © 2012 John Wiley & Sons, Ltd.     

Axial alignment of the lower limb in patients with isolated meniscal tear

Meniscal tears do not always result from trauma. To elucidate other factors responsible for meniscal tears, we evaluated the axial alignment of the lower limb in 385 patients (385 menisci) with isolated meniscal tear who were examined between 1972 and 1994. The patients were aged 50 years or less and had no ulceration or defect of articular cartilage of the knee when examined arthroscopically. Of the 385 menisci, 90 were lateral complete discoid; 110, lateral incomplete discoid; 68, lateral semilunar; and 117, medial semilunar. Patients in each of these four groups were divided into four subgroups according to sex and whether there was an obvious history of trauma. The so-called Mikulicz's mechanical axis of the affected side was utilized to evaluate the alignment. The axial alignment of the lower limb was normal in the patients with isolated tears of lateral complete discoid meniscus, lateral incomplete discoid, or lateral semilunar. It appeared that the axial alignment of the lower limb did not have a relationship with the occurrence of these tears. Patients with isolated tears of medial semilunar meniscus without obvious trauma, showed varus deformity of the knee. This deformity appeared to be closely related to the presence of medial meniscal tear. Received for publication on April 23, 1997; accepted on Sept. 9, 1997     

Uneventful splenectomy and cholecystectomy in a patient treated with anti-interleukin-6 receptor antibody therapy

Introduction Interleukin-6 (IL-6) is a multifunctional cytokine that regulates various aspects of the immune responses, acute phase reactions, and hematopoiesis. In rodent models, IL-6 has been suggested to be one of the essential mediators for optimal acute phase responses to infection and tissue damage. However, in humans, the roles of IL-6 in acute phase responses after surgery remain poorly understood. Case report We present the first case report of successful splenectomy and cholecystectomy in a severe autoimmune-associated hemolytic anemia patient during treatment with a humanized anti-IL-6 receptor antibody. Discussion This unique case suggests that IL-6 is not an essential cytokine to safely perform surgical intervention and to prevent postoperative complications and that surgical intervention may not be contraindicated but can be selected as a therapeutic modality in patients treated with anti-IL-6 receptor antibody therapy.     

Tumor necrosis factor-alpha attenuates thyroid hormone-induced apoptosis in vascular endothelial cell line XLgoo established from Xenopus tadpole tails

Amphibian metamorphosis induced by T(3) involves programmed cell death and the differentiation of various types of cells in degenerated and reconstructed tissues. However, the signaling pathway that directs the T(3)-dependent cell-fate determinations remains unclear. TNF-alpha is a pleiotropic cytokine that affects diverse cellular responses. Engagement of TNF-alpha with its receptor (TNFR1) causes intracellular apoptotic and/or survival signaling. To investigate TNF signaling functions during anuran metamorphosis, we first identified Xenopus laevis orthologs of TNF (xTNF)-alpha and its receptor. We found that xTNF-alpha activated nuclear factor-kappaB in X. laevis A6 cells through the Fas-associated death domain and receptor-interacting protein 1. Interestingly, xTNF-alpha mRNA in blood cells showed prominent expression at prometamorphosis during metamorphosis. Next, to elucidate the apoptotic and/or survival signaling induced by xTNF-alpha in an in vitro model of metamorphosis, we established a vascular endothelial cell line, XLgoo, from X. laevis tadpole tail. XLgoo cells formed actin stress fibers and elongated in response to xTNF-alpha. T(3) induced apoptosis in these cells, but the addition of xTNF-alpha blocked the T(3)-induced apoptosis. In addition, treatment of the cells with T(3) for 2 d induced the expression of thyroid hormone receptor-beta and caspase-3, and this thyroid hormone receptor-beta induction was drastically repressed by xTNF-alpha. Furthermore, in organ culture of the tail, xTNF-alpha significantly attenuated the tail degeneration induced by T(3). These findings suggested that xTNF-alpha could protect vascular endothelial cells from apoptotic cell death induced by T(3) during metamorphosis and thereby participate in the regulation of cell fate.     

Aortic spontaneous echocardiographic contrast and hemostatic markers in patients with nonrheumatic atrial fibrillation

OBJECTIVES: To determine the relationship between spontaneous echocardiographic contrast (SEC) in the descending thoracic aorta and plasma levels of hemostatic markers in patients with nonrheumatic atrial fibrillation (AF). DESIGN AND SETTINGS: A cross-sectional study at a university hospital. PATIENTS AND MEASUREMENTS: In 91 consecutive patients (mean +/- SE age, 70 +/- 1 years; 68 men) with nonrheumatic AF who underwent transesophageal echocardiography, plasma levels of markers for platelet activity (platelet factor 4 [PF4] and beta-thromboglobulin [beta-TG]), thrombotic status (thrombin-antithrombin III complex [TAT]), and fibrinolytic status (D-dimer and plasmin-alpha(2)-plasmin inhibitor complex [PIC]) were determined. RESULTS: Forty-three patients who had aortic SEC (AoSEC) were older (72 years vs 68 years; p < 0.05) and had a higher prevalence of chronic AF (88% vs 52%; p < 0.05) than 48 patients without AoSEC. TAT, PIC, and D-dimer levels were significantly higher in patients with AoSEC than in those without AoSEC, whereas PF4 and beta-TG levels were not different between the two groups. Although the prevalence of cerebral embolism did not differ between the two groups (23% vs 29%), the prevalence of peripheral embolism was higher in patients with AoSEC than in those without AoSEC (10% vs 0%; p < 0.05). Multivariate analysis revealed mitral regurgitation (odds ratio, 7.53; p < 0.02), SEC in the left atrium (odds ratio, 2.14; p < 0.02), and aortic atherosclerosis (odds ratio, 1.87; p < 0.04) emerged as independent predictors of AoSEC. CONCLUSIONS: Patients with nonrheumatic AF who have AoSEC appear to have enhanced coagulation activity but not platelet activity. Intensive anticoagulation treatment might be required for these patients.