An unconscious 75-year-old female was admitted to our hospital. She went into cardiopulmonary arrest in the emergency room, but was resuscitated successfully. Abdominal computed tomography revealed a ...massive hematoma in the stomach. Gastrointestinal endoscopy was performed, but the source of the bleeding could not be identified. An emergency laparotomy was performed under a diagnosis of a hemorrhagic gastric ulcer. Laparotomy revealed ulcerative lesions in the posterior wall of the upper body of the stomach. A total gastrectomy was performed and the patient was rescued. On postoperative day 35, Roux-Y reconstruction was performed. We report herein on a case of cardiopulmonary arrest due to a hemorrhagic gastric ulcer successfully treated with a two staged operation and discuss the clinical implications based on a review of the literature.
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•Carbonaceous sensing layers were prepared by radio-frequency sputtering of Japanese calligraphy solidink disc.•Collagen-sputtered films had a densely packed columnar structure with a ...high affinity for polar species.•Linear solvation energy relationships modeled the multiple regression equation for organic gas sorption capacities.
Japanese calligraphy solidink (sumi) is essentially made of dried gelatinous carbon and collagen peptides composed of enzyme-catalyzed gelatin. Humin-like carbonaceous films with packed columnar structures were prepared by the radio-frequency (rf) sputtering of these gelatin-based polypeptides. The collagen film has a slightly-cleft structure, whereas the sumi film has remarkably developed clefts. The sumi film has a lower elemental ratio of nitrogen than the collagen film. The well-cleft and nitrogen-poor characteristics of the sumi film are considered to be due to the oxidative species generated by the rf discharge of water vaporized from the sumi disc sputtering target. Collagen films have high absorption capacities for small polar species such as water, methanol, and ethanol. This selectivity is attributable to the densely packed columnar structure with electronegative atoms such as nitrogen and oxygen inducing high affinity for polar species. Linear solvation energy relationships were used to model the absorption behaviors of these carbonaceous films by means of the polar and dielectric characteristics of absorbate molecules. These physicochemical molecular descriptors are distinguishing attributes for the gas-sorption of carbonaceous sputtered films of gelatin-based polypeptides.
Background and Aim: To study the histological changes caused by transfection of the hepatocyte growth factor (HGF) gene using electroporation (EP) in a non‐alcoholic steatohepatitis (NASH) cirrhotic ...liver model.
Methods: NASH cirrhotic livers were prepared by administering a choline‐deficient diet to 5‐week‐old male Wister rats for 12 weeks. Three groups of rats were used: rats in the G(+) group were transfected with the GFP gene using EP, rats in the H(+) group were transfected with the HGF gene using EP, and rats in the H(–) group were only injected with the HGF gene. Rats were sacrificed 2 days after gene transfection, and the Azan positive rate (APR) and Sudan positive rate (SPR) were calculated to evaluate fibrosis and fatty changes.
Results: The APR of the NASH cirrhotic livers was significantly higher than that in the normal livers. The APR did not decrease in the G(+) group and the H(–) group, but decreased significantly in the nonelectroporated as well as electroporated areas of the H(+) group. For SPR, there were no significant differences between the G(+), H(–), and H(+) groups.
Conclusion: The improvement of fibrosis was not significant when a direct injection of the HGF gene was used alone, but it was enhanced by the concomitant use of EP. However, no efficacy was observed in fat components. These findings suggest that transfection of the HGF gene by EP may lead to an improvement of irreversible cirrhotic livers to reversible fatty livers.
We report a case of resected adenosquamous extrahepatic bile duct carcinoma concomitant with cholecystitis. A 79–year–old woman reporting general fatigue and jaundice was found in enhanced abdominal ...computed tomography (CT) and endoscopic retrograde cholangiopancreatography to have an extrahepatic bile duct tumor diagnosed as bile duct carcinoma. Preoperative restudy of the enhanced abdominal CT showed a dilated gallbladder with fluid collecting around it, necessitating pancreaticoduodenectomy. The dilated, severely inflamed gallbladder was abscessed around the greater omentum. The resected specimen showed a papillary–shaped tumor protruding from the mid bile duct wall into the common bile duct and obstructing the cystic duct orifice. Histopathological examination showed adenosquamous extrahepatic bile duct carcinoma and gallbladder cholecystitis.
A woman in her seventies visited a previous doctor because she was reported to have abnormal opacity in her right lung. Computed Tomography (CT) revealed pulmonary tuberculosis. An upper abdominal ...mass was also found, and she was referred to our hospital. Contrast-enhanced abdominal CT showed a heterogeneously mass lesion with a long diameter of approximately 83 mm in the pancreatic caudal region. Endoscopic ultrasound revealed a tumor at the pancreatic tail with distinct boundaries and internal mosaic echo. Magnetic Resonance Imaging showed a mass with heterogeneous and partially cystic degeneration. Based on these findings, solid pseudopapillary neoplasm (SPN) and other malignant lesions of the pancreas tail region were suspected. By laparotomy with subarachnoid arc incision, distal pancreatectomy, splenectomy, and regional lymph node dissection were performed. The specimen was a cystic mass covered with an 80×75×65 mm membrane in the pancreatic tail region. Initially, in the results of the pathological diagnosis, epithelial cells were not observed, and a hematoma was diagnosed. However, subsequent diagnosis indicated bizarre idioblasts and numerous osteoclast-like giant cells in the surrounding capsule. This area was initially thought to be a reactive pseudotumor lesion due to hemorrhage; however, the presence of CK7, p53-positive atypical spindle-shaped tumor cells and polynucleated tumor cells led to the diagnosis of anaplastic pancreatic carcinoma with osteoclastic polynucleic giant cells with extensive necrosis. We report a case of a rare pancreatic tumor with extensive intratumoral necrosis, which was difficult to diagnose pathologically, and present our findings with literature review.
The utility and minimal invasiveness of ultrasound-guided intranodal lymphangiography have already been reported by several researchers. Although ultrasound-guided intranodal lymphangiography is ...known to be not technically difficult in general, a patient’s edematous groin due to hypoalbuminemia resulting from chylous ascites made it too challenging to detect and prick the lymph nodes precisely. This report describes a 71-year-old female with refractory chylous ascites due to an operation for an extrahepatic bile duct cancer, who was successfully treated by computed tomography (CT)-guided intranodal lymphangiography. After switching from ultrasound- to CT-guided lymphangiography, the procedure was successfully performed, and the refractory chylous ascites was treated.
Patients with aortic valve stenosis have high perioperative risk. We evaluated 5 patients (3 males and 2 females) diagnosed with severe aortic valve stenosis on echocardiography who underwent ...laparotomy for preoperative intra-aortic balloon pump (IABP) insertion in our hospital between January 2011 and December 2015. The mean age was 72.2 years. One patient underwent emergency and 4 underwent emergency surgery for a malignancy. The mean aortic valve pressure gradient was 33.68 mmHg. The mean valve area was 0.723 cm2. The mean duration of IABP use was 3.4 days. No IABP complications or cardiac complications were noted. Insertion of an IABP before laparotomy for patients with severe aortic valve stenosis may be useful for perioperative management.
A 59-year-old woman was referred to our hospital because of barium reflux to the bile duct in the upper gastrointestinal series from an annual medical check-up suggesting gastrocholedocal fistula. ...Gastrointestinal endoscopy showed a small orifice in the lesser curvature of the middle stomach. MRCP and ERCP delineated an ectopic bile duct bifurcating from the left hepatic duct and a common bile duct with filling defects. We diagnosed double bile duct associated with choledocholithiasis and surgery was performed. In operative findings, an ectopic bile duct lay between the left hepatic duct and lesser curvature of the stomach in the lesser omentum. The other two bile ducts were newly detected in the operation, which joined into the ectopic bile duct. In cholangioscopy, these two had normal mucosa of the bile duct and drained the caudate lobe, and therefore diagnosed as accessory hepatic ducts. We performed a cholecystectomy, choledocholithotomy, and an ectopic and accessory bile duct resection with partial gastrectomy while preserving an accessory hepatic duct near the left hepatic duct. Pathologically, ectopic and accessory hepatic ducts showed a normal wall structure of the bile duct, and no malignancy. Here, we report a rare operative case of double bile duct with an accessory hepatic duct on the left side.
We report a case of primary mucinous adenocarcinoma of the appendix diagnosed by mucocele. An 83–year–old woman seen for a lower right abdominal cystic lesion was found in laboratory tests to have ...mild inflammation and elevated serum CEA and CA19–9. Ultrasonography and computed tomography (CT) showed a cystic mass 10 cm in diameter in front of the cecum and surrounded by inflammation. We diagnosed the mass as primary appendiceal neoplasm or abscess, conducting right hemicolectomy. The resected specimen showed mucinous discharge from the appendiceal orifice and a cyst communicating with the appendix. The pathological diagnosis was primary mucinous adenocarcinoma of the appendix.
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