Treatment Using the SpyGlass Digital System in a Patient with Hepatolithiasis after a Whipple Procedure

An 89-year-old man was referred to our hospital for treatment of hepatolithiasis causing recurrent cholangitis. He had undergone a prior Whipple procedure. Computed tomography demonstrated left-sided hepatolithiasis. First, we conducted peroral direct cholangioscopy (PDCS) using an ultraslim endoscope. Although PDCS was successfully conducted, it was unsuccessful in removing all the stones. The stones located in the B2 segment were difficult to remove because the endoscope could not be inserted deeply into this segment due to the small size of the intrahepatic bile duct. Next, we substituted the endoscope with an upper gastrointestinal endoscope. After positioning the endoscope, the SpyGlass digital system (SPY-DS) was successfully inserted deep into the B2 segment. Upon visualizing the residual stones, we conducted SPY-DS-guided electrohydraulic lithotripsy. The stones were disintegrated and completely removed. In cases of PDCS failure, a treatment strategy using the SPY-DS can be considered for patients with hepatolithiasis after a Whipple procedure.

Chronological Endoscopic and Pathological Observations in Russell Body Duodenitis

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.

Relation between Awareness of Medical Students and the Understanding of Kampo Medicine / 日本東洋医学雑誌

To clarify how students' awareness is linked to their understanding of Kampo medicine, we carried out a questionnaire and test for 94 fourth-year medical students (MS) following all the lectures at Yamaguchi University School of Medicine.Gender was not associated with performance in the test.MS having been admitted to an undergraduate program had a significantly better performance record in the test than did MS who had passed the usual university entrance examinations (P < 0.0001).MS who had experienced the efficacy of Kampo medicine had a significantly better performance record in the test than did MS who had not.Understanding of both the merits and demerits of Kampo medicine, a desire to see bedside teaching of Kampo medicine currently or in the future, and a desire to integrate Kampo medicine with primary care in the future were associated with a better performance record in the test.Multiple logistic regression analysis showed that admission to an undergraduate program (odds ratio (OR) = 6.9) and having experienced the efficacy of Kampo medicine (OR = 4.5) were independently contributing factors to a good performance record in the test.Taken together, these results suggest that experiencing efficacy and bedside teaching are needed to increase understanding of Kampo medicine for MS.