The role of magnetic resonance cholangiopancreatography (MRCP) after resection of the pancreas

Magnetic resonance cholangiopancreatography (MRCP) was performed in 35 patients to evaluate the feasibility of its use as a postsurgical imaging technique after resection of the pancreas. The surgical procedures performed were: pancreatoduodenectomy in 22 patients, segmental pancreatectomy in 1, distal pancreatectomy in 7, and pyroluspreserving pancreatoduodenectomy in 5. The pancreatic duct was shown in its entirety in 24 of the 35 patients (68.6%) and was partially visualized in 8 patients (22.9%), but the intrahepatic and extrahepatic bile ducts were visualized completely in all patients. Furthermore, MRCP was able to demonstrate lesions in 3 of 6 patients who had shown clinical evidence of recurrence. The visualization of the pancreatic and bile duct system was satisfactory despite anatomical changes brought about by resection of the pancreas. Thus, we conclude that MRCP is an appropriate follow-up screening test for patients with suspected abnormalities of the biliary and pancreatic duct system.     

Identification of tissue-embedded ascarid larvae by ribosomal DNA sequencing

Polymerase chain reaction (PCR) was applied to identify tissue-embedded ascarid nematode larvae. Two sequences of the internal transcribed spacer (ITS) regions of ribosomal DNA (rDNA), ITS1 and ITS2, of the ascarid parasites were amplified and compared with those of ascarid-nematodes registered in a DNA database (GenBank). The ITS sequences of the PCR products obtained from the ascarid parasite specimen in our laboratory were compatible with those of registered adult Ascaris and Toxocara parasites. PCR amplification of the ITS regions was sensitive enough to detect a single larva of Ascaris suum mixed with porcine liver tissue. Using this method, ascarid larvae embedded in the liver of a naturally infected turkey were identified as Toxocara canis. These results suggest that even a single larva embedded in tissues from patients with larva migrans could be identified by sequencing the ITS regions.     

Late-onset Leigh syndrome with myoclonic epilepsy with ragged-red fibers

We report the case of a boy with myoclonic epilepsy with ragged-red fibers (MERRF) who had astatic seizures since 2 years of age and later developed ataxia, absence seizures, and myoclonus. Almost homoplasmic A8344G mutation of mitochondrial DNA (m.8344A>G mutation) was detected in lymphocytes. He developed late-onset Leigh syndrome (LS) when he contracted pneumonia at 6 years. He developed bulbar palsy and deep coma. MRI demonstrated lesions in the brainstem, basal ganglia, and cerebral cortex. Three similar cases have been reported; two carried the almost-homoplasmic m.8344A>G mutation in muscle tissue. These suggested that almost homoplastic m.8344A>G mutation developed clinical phenotype of MERRF in the early stage and late-onset Leigh syndrome in the late course of the disease.     

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

Purpose

To examine the validity of our treatment strategy for spinal dural arteriovenous fistulae (SDAVF), based on the treatment results and the long-term outcome.

Methods

This study included 50 SDAVF patients (38 men, 12 women, mean age 63.2 years) with progressive myelopathy. The treatment strategy involved embolization as the initial management tool and surgery if embolization was considered unsuitable. Their medical records were evaluated to identify the treatment results and functional outcomes. The mean follow-up period was 81.2 months (range 27–184 months).

Results

Complete obliteration was achieved in 22 (71.0 %) of 31 embolized patients and in 18 of 19 (94.7 %) operated patients. The initial success rate was significantly lower in embolized than operated patients. At the last follow-up, 33 of the 50 patients (66 %) manifested improved gait and 16 (32 %) improved micturition. The activity of daily living (ADL) was improved in 33 (66 %). When we compared the rates of functional improvement at the last follow-up, there was no significant difference between patients treated initially by embolization or surgery.

Conclusions

The long-term outcomes in SDAVF patients treated by multidisciplinary management with first-line embolization were comparable to those in earlier surgical series. However, our results were unable to demonstrate the superiority of endovascular embolization to surgical treatment for SDAVF. For the purpose of justifying endovascular embolization as a first-line treatment for SDAVF, it will be necessary to show further improvement in both the initial treatment success and the complication rates.

     

Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy

Background  

Laparoscopic gastrectomy (LAG) is recognized as a less invasive surgery, but no advantage in terms of respiratory function recovery has been demonstrated. We investigated respiratory function recovery in the early period after LAG compared with open gastrectomy (OG) for measuring the recovery of oxygen saturation level (SaO₂).     

Ontogenic Expression of Somatostatin-Messenger RNA in the Intestinal Tract of Neonatal Rats

Ontogenic expression of somatostatin (SRIF)—messenger RNA (mRNA) in the gastrointestinal tract was examined in neonatal rats aged from 1 day preterm to 60 days postpartum in comparison with that in the hypothalamus. SRIF-mRNA in the hypothalamus was already expressed in prenatal rats and its developmental change was relatively small. In contrast, a unique pattern of SRIF-mRNA expression was seen in the different intestinal regions, gastric antrum, duodenum, jejunum and colon. In the duodenum, SRIF-mRNA level was low at birth, markedly increased during the postnatal 3 days and declined to the previous level by day 21. Jejunal SRIF-mRNA was found in neonates but progressively decreased in a similar way to duodenum. On the contrary, gastric SRIF-mRNA level, which was low during early development, rose rapidly to a peak on day 21 and gradually declined to an adult level. In the colon age-related change was not conspicuous, remaining at a low level. These results indicate that (1) expression of SRIF gene in the intestinal tract is regulated by local factor(s) as well as developmental stage, and (2) shift of SRIF-mRNA pattern occurs during weaning from the duodenum-dominant infantile pattern to the gastric-dominant adult pattern.     

Assays for thyroid-stimulating antibodies and thyrotropin-binding inhibitory immunoglobulins in children with Graves' disease

Studies on thyrotropin receptor autoantibodies (TRAb) by measurement of both thyroid-stimulating antibodies (TSAb) and thyrotropin-binding inhibitory immunoglobulins (TBII) in serum from children with Graves' disease are limited in number of studies. The aim of this study was to investigate the levels of serum TSAb and TBII in children with Graves' disease, and to evaluate the clinical significance of these antibodies. We measured the serum TSAb and TBII at diagnosis and during management in 65 children with Graves' disease. Patients were divided into four groups according to their metabolic state: those with untreated active Graves' disease, those receiving treatment with antithyroid drugs, those in remission, and those in relapse. At diagnosis, both TSAb and TBII assays had high sensitivities and high specificities. In follow-up, the levels of both TSAb and TBII paralleled the course of the disease. There was a strong positive correlation between TSAb and TBII. TBII levels were significantly higher in the patients with ophthalmopathy than those without ophthalmopathy in untreated Graves' children. It was concluded that TSAb and TBII measurements are valuable in the diagnosis and management of children with Graves' disease.     

Study of multiple cerebral aneurysms comprised of both ruptured and unruptured aneurysm--an analysis of incidence rate with respect to site and size

The purpose of this investigation was to study the incidence rate of rupture with respect to the site and size of multiple cerebral aneurysms that include both ruptured and unruptured aneurysms. Site and size were investigated in 58 cases of this type of multiple cerebral aneurysm. All cerebral aneurysms were examined with MR angiography, 3D-CT angiography and digital subtraction angiography, as well as seeing measured using 3D-CT or digital subtraction angiography. As regards the site of the 58 ruptured cerebral aneurysms under study, 18 were internal carotid aneurysms (C2 or C3: 4 cases, IC-PC: 12 cases, IC-ancho.: 1 case, IC terminal: 1 case), 25 were anterior communicating aneurysms, 10 were middle cerebral aneurysms, 4 were anterior cerebral aneurysms and 1 case was a VA-PICA aneurysm. The ruptured internal carotid aneurysms were 4.0-21.0 mm in size, the anterior communicating aneurysms were 1.8-13 mm, the middle cerebral aneurysms were 2.0-21.3 mm, the anterior cerebral aneurysms were 3.2-9.1 mm, and the VA-PICA aneurysm was 4.4 mm. The sites of the 89 unruptured cerebral aneurysms break down as follows: 29 were internal carotid aneurysms (C2 or C3: 4 cases, IC-PC: 10 cases, IC-ancho.: 10 cases, IC terminal: 5 cases), 18 were anterior communicating aneurysms, 34 were middle cerebral aneurysms, and there were 5 cases of posterior circulation aneurysm. In size, the unruptured internal carotid aneurysms were 1.0-18.3 mm, the anterior communicating aneurysms were 1.0-6.5 mm, the middle cerebral aneurysms were 1.0-10.3 mm, the anterior cerebral aneurysms were 1.0-3.3 mm, and the posterior circulation aneurysms were 2.2-17.3 mm. Out of 58 ruptured cerebral aneurysms, 44 were of the largest size category, and 53 (91.4%) were in the largest size category and/or anterior communicating aneurysms. The accumulated incidence rate of rupture of anterior communicating aneurysms rose suddenly upon reaching 2 mm in size, and after reaching 3 mm, these aneurysms accounted for a nearly uniform 55%-60% of the incidence rate of rupture. The accumulated incidence rate of rupture of IC-PC aneurysms rose drastically at 4 mm in size with the data describing a parabolic slope when graphed. IC-PC aneurysms represented a uniform 55% of the incidence rate of rupture after reaching 8 mm in size. The accumulated incidence rate of rupture of middle cerebral aneurysms rose in a gently sloping parabola beginning at 4 mm, and stabilized at 20% upon reaching 10 mm. These results suggest that each site is associated with a characteristic size and rate of aneurismal rupture. Special attention should thus be paid to large and anterior communicating aneurysms when operating on multiple cerebral aneurysms.