ABSTRACT
Background: Total pancreatectomy (TP) for pancreatic neoplasms has not been shown to confer any benefit over less aggressive resections, and is associated with high morbidity and mortality rates. Recently, clinical indications for TP are increasingly reported, with advances in surgical techniques, improvements in glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes. TP is indicated for patients with large invasive tumors, multifocal intraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, and longstanding chronic pancreatitis. Clinicophysiological findings after TP have only been reported in a small number of cases, however. The aim of this study was to evaluate clinicophysiological outcomes after TP. Methods: A total of 41 patients who underwent TP between 2007 and 2013 at Tokyo Women’s Medical University were examined retrospectively. Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, total cholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liver in CT) were collected and analyzed from preoperative state to 12 month after TP (preoperative condition,1 month, 3 months, 6 months, and 12 months after TP). Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured 12 months after TP. Average values were compared with Student’s t-test, and numeric data are expressed as mean ± SD. Results: There were 23 male and 18 female patients. The mean age was 65.2 years (range, 47–77 years). There were 25 patients with intraductal papillary mucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 with invasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillary neoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma. Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwent subtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preserving TP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2; HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT, 63.05 ± 0.90 HU. No statistically significant differences in clinicophysiological parameters were observed, except in HbA1c, which was significantly different between the preoperative state and 12 months after TP. Albumin, creatinine, lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, but had normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin, 24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes (lipase) was 18000 U, 12 month after TP. Conclusions: Several clinicophysiological parameters, with the exception of HbA1c, were temporarily decreased after TP, but had normalized by 12 months. Therefore, treatment of pancreatic neoplasms with the potential to spread across the entire pancreas by TP is feasible, and should be supplemented with adequate administration of synthetic insulin and pancreatic enzyme supplements.
ABSTRACT
Background: Total pancreatectomy (TP) for pancreatic neoplasms has not beenshown to confer any benefit over less aggressive resections, and is associatedwith high morbidity and mortality rates. Recently, clinical indications for TP areincreasingly reported, with advances in surgical techniques, improvements inglycemic monitoring, and the development of synthetic insulin and pancreaticenzymes. TP is indicated for patients with large invasive tumors, multifocalintraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, andlongstanding chronic pancreatitis. Clinicophysiological findings after TP haveonly been reported in a small number of cases, however. The aim of this studywas to evaluate clinicophysiological outcomes after TP.Methods: A total of 41 patients who underwent TP between 2007 and 2013at Tokyo Women’s Medical University were examined retrospectively.Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, totalcholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liverin CT) were collected and analyzed from preoperative state to 12 month after TP(preoperative condition,1 month, 3 months, 6 months, and 12 months after TP).Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured12 months after TP. Average values were compared with Student’s t-test, andnumeric data are expressed as mean ± SD.Results: There were 23 male and 18 female patients. The mean age was 65.2years (range, 47–77 years). There were 25 patients with intraductal papillarymucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 withinvasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillaryneoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma.Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwentsubtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preservingTP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2;HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT,63.05 ± 0.90 HU. No statistically significant differences in clinicophysiologicalparameters were observed, except in HbA1c, which was significantly differentbetween the preoperative state and 12 months after TP. Albumin, creatinine,lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, buthad normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin,24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes(lipase) was 18000 U, 12 month after TP.Conclusions: Several clinicophysiological parameters, with the exception ofHbA1c, were temporarily decreased after TP, but had normalized by 12 months.Therefore, treatment of pancreatic neoplasms with the potential to spread acrossthe entire pancreas by TP is feasible, and should be supplemented with adequateadministration of synthetic insulin and pancreatic enzyme supplements.
ABSTRACT
This study was conducted to assess the ability of two-dimensional tissue tracking (2DTT) to evaluate changes in left ventricular (LV) myocardial function associated with sustained high electrical pacing. Pacemakers were implanted at the right ventricular (RV) apex of five female Beagles, and sustained high electrical pacing of 250 beats per minute (bpm) was performed for three consecutive weeks. Conventional echocardiography and 2DTT were performed at baseline, and at every week for three weeks with pacing. The baseline parameters were then compared to those of weeks 1, 2, and 3. Three weeks of pacing resulted in significant reduction of radial and circumferential global strains (p < 0.001). Regional analysis revealed reduction of segmental strains in both radial and circumferential directions, as well as increased dyssynchrony after three weeks of pacing in the radial direction (p = 0.0007). The results of this study revealed the ability of 2DTT to measure radial and circumferential strains in dogs with sustained high-electrical pacing, and allowed assessment of global and regional myocardial function and the degree of dyssynchrony.
Subject(s)
Animals , Dogs , Female , Cardiac Pacing, Artificial , Echocardiography/methods , Heart Rate , Heart Ventricles/diagnostic imaging , Ventricular Function, LeftABSTRACT
Despite their wide clinical application and success, our understanding of the effects of insoles is relatively limited. The purpose of this study was to assess the biomechanical effects of wearing lateral/medial wedged insoles on subtalar and knee joints during normal walking. Motion analysis was conducted with a 3D motion-analysis system and a ground reaction force analysis using force plate when subjects walked with three different insole conditions : 5-degree medial wedge, no wedge, and 5-degree lateral wedge. Significant differences were found in subtalar or ankle joint motion in coronal and sagittal planes compared with the no-wedge condition. No differences were found in knee joint motion in the coronal and axial planes. The lateral-wedge insole reduced the knee varus moment and increased subtalar pronation moment in mid-stance during walking. At footstrike, however, the lateral wedge increased the knee varus moment and reduced the subtalar supination moment. The medial-wedge insole increased the knee varus moment and decreased subtalar pronation moment during the mid-stance phase. However, the medial wedge reduced the knee varus moment and increased subtalar supination moment at footstrike. The results of this study indicate that the influence of the insoles varied during the stance phase. Therefore, it is requested to select the shape of insole based on the injury mechanism, the location of the pain and the injury prevention.
ABSTRACT
Records on every 6 hour symptom were kept for the period from July 15 through November 30, 1983 by 19, 19 and 26 patients who were outpatients at the Sapporo Civil Hospital, the University of Tokyo Hospital and the University of Ryukyu Hospital. Every 6 hour fluctuations in percentage of asthmatic symptoms were calculated from these records.<br>Meteorological conditions prevailing each city were classified into 9 patterns, i. e., west-high-east-low pattern, north-high pattern, south-high-north-low pattern, east-high-west-low pattern, ridge pattern, trough pattern (east-west), migratory anticyclone pattern, trough pattern (south-north) and tropical depression pattern.<br>An asthma frequency (AF)in days under a certain type of meteorological conditions was compared with that in all the other days. Asthmatic symptoms were more frequent in the days under west-high-east-low pattern and those under migratory anticyclone pattern were also higher. An AF in days under south-high-north-low pattern and that in days under trough pattern (east-west) were lower.<br>Most of days under west-high-east-low pattern were in late autumn in each of the 3 cities. The temperature of the days in Tokyo under this pattern were lower than the control days which belonged to the same period. Days under migratory anticyclone pattern were in the whole period of this study in Sapporo, in autumn in Tokyo and Naha. The temperature of these days in Sapporo and Tokyo was significantly lower than those of the control days.<br>Most of days under south-high-north-low pattern were in summer in each of the 3 cities. The temperature of the days in Tokyo under this pattern was significantly higher than those of the controls. Days under trough pattern (east-west) were from late summer to autumn in Naha. There was no difference in the temperature between the days under this pattern and the control days.<br>In summary, some of meteorological conditions had acute effects on asthma frequencies. When significant differences were observed in the temperature, it was lower (higher) in the days under a meteorological condition, under which the asthma frequency was high (low), than in the control days which belonged to the same period.