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.
We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the pylorus. A 73-year-old man came to our hospital presenting with ...epigastralgia. Esophago-gastroduodenal endoscopy showed no mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round masses. One was located in the pylorus, while the other was found between the portal vein and the inferior vena cava. An examination of a biopsy specimen was inconclusive. We diagnosed a gastrointestinal stromal tumor or malignant lymphoma preoperatively, and decided to perform an operation in order to confirm the diagnosis and select the optimal treatment. Intraoperatively, the mass in the pylorus invaded the pancreatic head, and the lymph node in the hepatoduodenal ligament was swollen. We performed a pancreaticoduodenectomy as a radical excision. The resected specimen showed the 7.6 x 4.9-cm size tumor to mainly originate from the pylorus. Histopathologically, the tumor was identified as pancreatic ACC with lymph node metastasis. The tumor cells were labeled by immunohistochemical staining for alpha1-antitrypsin. Because of the tumor location, we considered the tumor to have originated from the ectopic pancreatic tissue in the stomach. This is only the second case of ACC originating from an ectopic pancreas reported in the literature.
The rheological behaviors of clustered and disentangled multiwalled carbon nanotubes (MWCNTs) dispersed in a stable, non-reactive Newtonian epoxy fluid have been investigated. Suspensions of ...untreated and chemically oxidized MWCNTs in epoxy show strong rate-dependent behavior and long-time elastic response that is characteristic of a flocculated microstructure. Suspensions of disentangled MWCNTs in epoxy were prepared by a functionalization reaction with nitrobenzene, and show distinct rheological behavior that is attributed to the motion and rotation of the individual nanoparticles. Characteristic features of the disentangled MWCNTs in epoxy are a lack of low-frequency plateau in storage modulus and shear thickening behavior at high shear rate. The rheological behavior is discussed on the basis of continuum-level predictions for the motion of individual, semiflexible fibers under shearing flows. Implications of MWCNT disentanglement on fundamental study and applications of MWCNT-filled systems are discussed.
Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; ...however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult. Here we report a case of obscure gastrointestinal bleeding (GIB) due to ectopic varices in the small intestine that flowed into the inferior epigastric vein. Our observations suggest that when obscure GIB is detected in patients with either cirrhosis or post-surgical history including incisional hernia, it is essential to acquire multilanar reconstruction images and volume-rendered 3-dimensional reconstruction of computed tomography scans to investigate the complex venous supply and optimize decisions for therapy.
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.
We studied the effects of portal–systemic shunt after massive hepatectomy. Male Wistar rats were divided into two groups: one group underwent laparotomy alone (C group) and in the other group a ...portal–systemic shunt was placed through laparotomy (S group). After 90% hepatectomy was performed, 3-day and 1-week survival rates and histopathology were examined, and hepatic hemodynamics during the early stage after hepatectomy were measured using dye-containing microspheres. The 3-day survival rate in the S group was significantly higher, and the 1-week survival rate was slightly higher, than those in C group. Sinusoidal dilation 7 days after hepatectomy in the S group was significantly milder than that in the C group. Fatty degeneration of hepatocytes in the S group was significantly milder than that in the C group. With respect to hepatic hemodynamics during the early stage after hepatectomy, the rate of shunt (26.3%) in the S group was significantly higher than that (9.5%) in the C group. Portal pressure, total hepatic blood flow, and total hepatic blood flow per gram of liver in the S group were significantly lower than those in the C group. These results suggest that approximately 26% shunt after 90% hepatectomy in rats increases the early survival rate and improves histological changes in surviving rats 7 days after resection.
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.
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