Portal annular pancreas (PAP) is a congenital anomaly resulting from aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein (PV). PAP was classified into three types by ...Joseph et al., based on the location of the main pancreatic duct around the PV. The presence of PAP is important for the surgical procedure because it is associated with the postoperative pancreatic fistula. There are no standardized surgical procedures of resection and reconstruction for PAP.
We report 2 cases of subtotal stomach-preserving pancreatoduodenectomy in patients with PAP. One case of PAP was discovered coincidentally intraoperatively, and the other case was diagnosed before surgery. The first case was an 84-year-old male patient who underwent surgery for distal bile duct cancer. PAP was noticed intraoperatively when the uncinate process of the pancreas was detached from behind the PV. The second case was an 84-year-old female patient who also underwent surgery for distal bile duct cancer. We recognized PAP from preoperative computed tomography images. In both cases, the ductal anatomy was consistent with type IIIA PAP, and the dorsal pancreas was resected using a stapling device. During the postoperative period, there was no clinically relevant postoperative pancreatic fistula.
PAP is rarely encountered intraoperatively; however, it is important to recognize it before surgery and take it into consideration when deciding upon the procedures for resection and reconstruction.
Schwannoma is the most frequent mediastinal tumor after thymoma and teratoma, and most often arises in the posterior mediastinum. It usually originates from sympathetic or intercostal nerves, and ...schwannoma of phrenic nerve origin is rare. The patient was a woman in her 40s who was referred to our department for surgery after computed tomography (CT) in 2021 revealed a mediastinal mass of 4 cm in diameter. Review of previous CT from 2017 identified the mass and confirmed an increase in size over time. Thoracic magnetic resonance imaging showed a low signal intensity on T1-weighted imaging, while T2-weighted imaging showed a high signal intensity at the margins and inhomogeneous low signals in the interior. Positron emission tomography-CT showed focal accumulation of fluorodeoxyglucose (maximum standardized uptake value, 3.95). Based on these imaging results, we suspected a thymoma and performed robot-assisted thymectomy. Since invasion of the left phrenic nerve by a malignant tumor could not be ruled out, we performed combined resection. Rapid pathology revealed schwannoma. The postoperative course was uneventful and the patient was discharged from the hospital on postoperative day 6. We report our experience of a rare case of robot-assisted surgery for schwannoma of phrenic nerve origin.
In 2013, the European Union expanded the list of hazardous substances contained in the RoHS Directive. In addition, certain phthalate esters, such as dibutyl phthalate (DBP), butyl benzyl phthalate ...(BBP), di-2-ethylhexyl phthalate (DEHP) and diisobutyl phthalate (DIBP), will be categorized as RoHS-prohibited substances starting from July 2019. Although pyrolysis-gas chromatography-mass spectrometry (Py-GC-MS) is a promising analytical method for the screening of phthalate esters, we have developed a novel soft-ionization MS method that is quantitative as well as faster and more convenient for this purpose. The sample was measured three times, after providing the calibration curve using a powdery standard material of SPEX. The data collection time is 5 min, and continuous measurements are completed within 8 min per sample. The mass spectrum was corrected by dividing the intensity by the sample weight. For the coefficient of variation, DBP was 2.9%, BBP was 3.4%, DEHP was 3.6%, and good reproducibility was observed. Precise analyses of phthalate esters using traditional methods can require solvent extraction times of up to 24 h as well as special techniques. Therefore, a screening method that can be easily carried out by anyone within ten minutes is very attractive.
This is a case of 60-year-old male patient with a history of heavy alcohol consumption and liver dysfunction who presented with a giant hepatic aneurysm. The incidence of giant hepatic aneurysms ...exceeding 10 cm in diameter is rare, particularly in the context of pseudoaneurysms. Furthermore, simultaneous perforation into the bile duct and duodenum is highly unusual. This case report elucidates the successful surgical management of a large pseudoaneurysm of the common hepatic artery that concurrently perforated the bile duct and duodenum, without any complications or deterioration of liver function.
The present medical case report describes successful endovascular treatment via stent graft and coil packing for a ruptured lumbar artery aneurysm in a 55-year-old woman with neurofibromatosis type ...1. Although less common, vasculopathy, such as an aneurysm, stenosis, rupture, and arteriovenous fistula, have been reported and can be a cause of death for patients with this disorder. However, only a few cases of a ruptured lumbar aneurysm have been reported.
Concrete with high content of admixture is effective in reducing the stress-strength ratio because of the low heat generation associated with the hydration reaction. However, concrete with high ...content of admixture is out of the scope of general stress-strength ratio estimation formulas. Therefore, the authors conducted an analytical study and developed a stress-strength ratio estimation formulas for concrete with high content of admixture. Case studies using this estimation formula showed that the estimated values can be evaluated safer than the analytical values, and that concrete with high content of admixture is more applicable to massive concrete.
A 60‐year‐old woman with an abnormality discovered during a chest X‐ray was referred to the authors' hospital for diagnosis and treatment. Upon enhanced computed tomography (CT), endoscopic ...ultrasonography, and magnetic resonance imaging, a tumor on the left side of the lower thoracic esophagus was detected. We diagnosed mediastinum cyst. One year after the first visit, a CT examination confirmed an increase in lesion size. Therefore, surgery was performed using a left thoracoscopic approach in the prone position. Before surgery, 3D models were used for simulation. Excision was performed without leakage of the contents. The histopathological diagnosis was a bronchogenic cyst. The left thoracoscopic surgery in the prone position is an uncommon approach but is useful for resecting tumors in the left side of the lower mediastinum. The authors were well‐prepared and able to perform safe and reliable surgery.
Emergency surgery for patients with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be avoided if possible because of increased risks of postoperative complications in ...patients and infection of medical staff members. We experienced a case of duodenal ulcer perforation that developed after SARS-CoV-2 infection. A 63-year-old man visited our hospital because of tiredness, and SARS-CoV-2 infection was confirmed. His general condition was good and followed up. The next day, he returned to the hospital because of abdominal pain and vomiting. Although his SARS-CoV-2 infection symptoms were mild, he was admitted to the hospital with a diagnosis of acute renal failure due to dehydration. An upper gastrointestinal perforation was revealed by computed tomography performed at the time of admission. Conservative therapy was selected because the abdominal symptoms were localized and inflammatory reaction was mild. However, laparotomy lavage drainage and gastrojejunos- tomy were needed because it worsened to generalized peritonitis. Despite adequate drainage and concomitant use of antibiotic therapy, multiple intra-abdominal abscesses formed. Additional drainage was required, and a long time was required for improvement of the inflammation. For patients with SARS-CoV-2 infection, the appropriate timing of emergency surgery, surgical procedures, and perioperative management is important to reduce complications.
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