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.     

Associations between Chest CT Abnormalities and Clinical Features in Patients with the Severe Fever with Thrombocytopenia Syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus. It involves multiple organ systems, including the lungs. However, the significance of the lung involvement in SFTS remains unclear. In the present study, we aimed to investigate the relationship between the clinical findings and abnormalities noted in the chest computed tomography (CT) of patients with SFTS. The medical records of 22 confirmed SFTS patients hospitalized in five hospitals in Nagasaki, Japan, between April 2013 and September 2019, were reviewed retrospectively. Interstitial septal thickening and ground-glass opacity (GGO) were the most common findings in 15 (68.1%) and 12 (54.5%) patients, respectively, and lung GGOs were associated with fatalities. The SFTS patients with a GGO pattern were elderly, had a disturbance of the conscious and tachycardia, and had higher c-reactive protein levels at admission (p = 0.009, 0.006, 0.002, and 0.038, respectively). These results suggested that the GGO pattern in patients with SFTS displayed disseminated inflammation in multiple organs and that cardiac stress was linked to higher mortality. Chest CT evaluations may be useful for hospitalized patients with SFTS to predict their severity and as early triage for the need of intensive care.     

Role of intrasplenic hepatocyte transplantation in improving survival and liver regeneration after hepatic resection in cirrhotic rats

We studied the effect of preoperative hepatocyte transplantation on the prevention of liver failure in cirrhotic rats after hepatic resection. Two groups of Lewis rats were rendered cirrhotic by i.p. injection of 1% dimethylnitrosamine and were subjected to 33% hepatectomy. Two days before the resection, 36 rats in group I received intrasplenic hepatocyte transplantation, and 25 rats in group II were given intrasplenic injection of normal saline as a control. By the end of the third postoperative day, the rats in group I had better survival and a better biochemical profile than those in group II. The liver growth rate and the labeling index of proliferating cell nuclear antigen (PCNA-LI) showed a steady rise in group I. Compared with group II, group I had a significantly lower transforming growth factor (TGF-beta1) level (p < 0.05). We conclude that preoperative intrasplenic hepatocyte transplantation improves survival and facilitates regeneration in cirrhotic rats after hepatic resection.     

Progressive disseminated histoplasmosis in an immunocompetent patient as an underrecognized imported mycosis in Japan

Histoplasmosis caused by Histoplasma capsulatum is found worldwide. Japan is known to be non-endemic area. Progressive disseminated histoplasmosis (PDH) is a severe form of histoplasmosis. We report a case of PDH in a 54-year-old male who was not immunocompromised. His last travel history to an endemic region was 2 years before onset. He was diagnosed as histoplasmosis by 18S rRNA-PCR from serum and ascites and immunodiffusion test. We treated him with parental liposomal amphotericin B for 2 weeks then changed to oral itraconazole, which was continued for 6 months. Rigorous work up, including HIV status, lymphocyte counts, and adrenal function did not reveal any evidence of immunosuppression of the patient. Our case suggests that PDH can occur in immunocompetent patients as previously described, and must be included in the differential diagnoses if presentation is consistent. In addition, the skills of travel history taking are emphasized.     

Effectiveness of immunochemotherapy with PSK, a protein-bound polysaccharide, in colorectal cancer and changes of tumor marker

In the present study, curatively resected patients of colorectal cancer at pTNM stages II and III were selected. Patients receiving postoperative combined PSK, a protein-bound polysaccharide, and fluoropyrimidine therapy (PSK + chemotherapy group) were compared with patients receiving postoperative chemotherapy alone (chemotherapy group) during the same period of study. Three-year disease-free survival rates were evaluated and the postoperative changes of serum type IV collagen level were investigated. The results confirmed a significant improvement of the three-year disease-free survival rate in the PSK + chemotherapy group compared to the chemotherapy group, suggesting that PSK is useful as postoperative prognosis control including relapse prevention for colorectal cancers at pTNM stage II and III. Analysis of the postoperative changes of serum type IV collagen level showed significantly higher levels in the chemotherapy group than in the PSK + chemotherapy group, and this tendency was sustained for 12 months after surgery. This observation is speculated to be caused by inhibition of vascular basement membrane destruction by PSK, leading to inhibition of release of type IV collagen into the blood. These results indicated a possibility that combined PSK and chemotherapy inhibited metastasis, thereby reducing the risk of relapse and leading to improvement of the three-year disease-free survival rate.     

CT air-contrast enema as a preoperative examination for colorectal cancer

BACKGROUND/AIMS: We conducted a study on three-dimensional computed tomography (CT) images, in particular CT air-contrast enema (CT enema), using multidetector-row CT (MDCT), to see whether CT enema is useful as a preoperative examination for colorectal cancer. We aimed to evaluate the detectability of lesions and the depth of cancer invasion using CT enema. METHODS: 292 patients (328 lesions) with colorectal cancer were enrolled. After an adequate insufflation of the large intestine, MDCT scans were performed. With the data obtained by MDCT, we reconstructed CT enema images. CT enema images were assessed for the detectability of lesions. The depth of invasion was evaluated by the deformity of the lesion on profile images. The deformities were divided into five groups: no deformity, slight deformity, mild deformity, moderate deformity and severe deformity. RESULTS: The detectability of lesions was 97.3%. The reasons for undetectability were due to residual fluid in 8 cases and insufficient colonic distention in 1 case. As the depth of invasion increased, the grade of the deformity became severer (p < 0.0001). CONCLUSIONS: CT enema proved to be an excellent examination tool to detect lesions. The deformity demonstrated by CT enema could be an additional source of information to predict the depth of invasion.     

Microsatellite instability in patients with gastric remnant cancer

Background. About 2% of patients who undergo partial distal gastrectomy for gastroduodenal diseases develop gastric remnant cancer 10 to 30 years after the gastrectomy. It is important in clinical practice to determine a molecular marker to identify patients susceptible to gastric remnant cancer. Methods. We investigated nine gastric remnant cancers (from nine individuals who had gastrectomies for primary gastric cancer or gastroduodenal ulcer) for microsatellite instability (MSI) at six loci, using the polymerase chain reaction (PCR). A control group of ten patients with sporadic gastric cancers in the upper third of the stomach was also similarly analyzed. Results. MSI was demonstrated in eight of nine cancers from the individuals who had had primary gastric cancer or gastroduodenal ulcer (88.9%) compared with two of ten cancers from the individuals with sporadic gastric cancer in the upper third of the stomach (20%). Conclusion. These results suggest that one or more MSI is associated with remnant gastric cancer after gastrectomy. Received on Sept. 6, 1999; accepted on Dec. 20, 1999