Nonoperative management without nasogastric tube decompression for adhesive small bowel obstruction.

BACKGROUND: Although nasogastric tube (NGT) decompression is widely used in nonoperative management for adhesive small bowel obstruction (SBO), robust evidence is lacking to support this routine practice. METHODS: Patients who received nonoperative management with a diagnosis of adhesive SBO were retrospectively reviewed. Those who received NGT or long-tube decompression at admission were categorized into the NGT group, while those who initially had no NGT placement were categorized into the non-NGT group. The incidence of vomiting after admission, pneumonia after admission, and the need for surgery were compared. RESULTS: Among 288 patients, 148 (51.3%) had non-NGT conservative treatment. There were no significant differences in the incidence of vomiting (NGT vs non-NGT: 12.9% vs 18.9%, p = 0.16), pneumonia (1.4% vs 0%, p = 0.235), or need for surgery (12.9% vs 7.4%, p = 0.126). CONCLUSIONS: While NGT decompression is a standard of care for adhesive SBO, selective NGT insertion for patients with persistent nausea or vomiting can become an option.

Internal hernia of the stomach through the lateral space of the colostomy: a case report.

An 81-year-old woman had undergone laparoscopic abdominoperineal resection for rectal cancer. A permanent colostomy was created through an intraperitoneal route. Three months after the surgery, the patient presented with lower abdominal pain and vomiting. Computed tomography showed gastric incarceration through the lateral space of the lifted sigmoid colostomy. Although the herniated stomach was reduced by nasogastric tube decompression, the patient experienced a recurrence of gastric hernia shortly thereafter. A laparoscopic operation was performed, and a new colostomy was constructed through an extraperitoneal route. The patient had no hernia recurrence during the 20 months of follow-up after the operation. Gastric internal hernia associated with colostomy can occur as a rare complication. Although reduction of the incarcerated stomach is possible by nasogastric tube decompression, surgical repair of the hernia may be the optimal management to prevent recurrence.

Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament: A case report.

BACKGROUND: A right-sided round ligament (RSRL) is a rare, congenital anomaly of the intrahepatic portal vein, with a reported frequency of 0.2%-1.2%. For patients with perihilar cholangiocarcinoma associated with an RSRL, an accurate understanding of the vascular and biliary anatomy is indispensable. CASE SUMMARY: We report a 70-year-old male with perihilar cholangiocarcinoma associated with an RSRL. After percutaneous transhepatic embolization of the left and anterior portal branches, we conducted a left trisectionectomy of the liver with extrahepatic bile duct resection and hepaticojejunostomy. The postoperative course was uneventful, and R0 resection was achieved. When the liver volume of each section was compared between 7 patients with an RSRL and 20 patients with normal portal vein anatomy, the posterior section in RSRL patients was significantly larger than that in patients with normal portal vein anatomy (median: 457 mL vs 306 mL, P = 0.031). In patients with perihilar cholangiocarcinoma associated with an RSRL, left trisectionectomy has several surgical advantages: (1) The posterior branch of the portal vein often ramifies independently, and the division of the portal vein is easily conducted; (2) A relatively large amount of remnant liver can be retained; and (3) The anatomy of the posterior branch of the Glissonian pedicle is similar to that in patients with normal anatomy. CONCLUSION: In patients with an RSRL and perihilar cholangiocarcinoma that does not involve the posterior section, left trisectionectomy may be a favorable choice.

Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report.

BACKGROUND: Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR). CASE PRESENTATION: The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission. CONCLUSIONS: Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.

Rupture of the common bile duct due to blunt trauma, presenting difficulty in diagnosis.

Rupture of the common bile duct because of blunt trauma is extremely rare. Preoperative diagnosis is very difficult because bile causes little peritoneal irritation. We present a case of a 19-year-old young woman with rupture of the common bile duct due to blunt trauma. She arrived at our hospital 1 hour after a car accident. She was diagnosed as pancreatic head injury, and conservative therapy was administered. It was effective, but after starting oral intake 6 days after the injury, she presented with abdominal fullness because of increased ascites. The ascites contained large amounts of bile. Rupture of the common bile duct became apparent, thus, she underwent emergency surgery 13 days after the injury. The common bile duct was ruptured completely at the lower bile duct. We repaired it by choledochojejunostomy. Her postoperative course was uneventful, and she discharged on the 12 days after the surgery. Preoperative drip-infusion-cholangiography-CT was useful for its diagnosis.

A case of acute cerebellitis with a unique sequential change on magnetic resonance imaging.

BACKGROUND: Acute cerebellitis with unilateral onset is rare, and magnetic resonance imaging (MRI) is a useful method for demonstrating cerebellar involvement. PATIENT: We report a 12-year-old girl with acute cerebellitis with a unique sequential change on her MRI. RESULTS: The patient's brain MRI first revealed cortical lesions mainly in the right cerebellar hemisphere. These subsequently disappeared, and at the same time, new lesions appeared in the opposite cerebellar hemisphere. All the lesions were confined to gray matter in the cerebellum and were isotense on diffusion-weighted imaging and had high signal intensity on the apparent diffusion coefficient map, consistent with the characteristic of vasogenic edema. CONCLUSION: The sequential MRI demonstrates conversion of hemicerebellitis to bilateral cerebellitis during subacute phase, and vasogenic edema might be contributing to the pathogenesis of acute cerebellitis in this patient.

Protective effect of montmorillonite on plasmid DNA in oral gene delivery into small intestine.

Montmorillonite, a bioinert clay mineral, was examined as a novel vector for an oral gene-delivery system. The complex of montmorillonite and plasmid DNA encoding the enhanced green fluorescent protein (EGFP) gene was prepared at various weight ratios, and then transfected into cultured intestinal epithelial cells (IEC-6) in vitro. The EGFP gene was clearly transcribed when the transfection was performed using the montmorillonite-plasmid complex at a weight ratio of 0.05:1. In contrast, no gene expression was detected by reverse transcription-polymerase chain reaction (RT-PCR) analysis when the transfection was performed with naked plasmid. Various plasmid preparations were given orally to mice, and the gene expression in the stomach and small intestine was examined by RT-PCR. Although no gene expression was detected in the mice receiving an oral administration of naked plasmid or polyethyleneimine-plasmid complex, the EGFP gene complexed with montmorillonite was expressed in the small intestine. These results indicate that montmorillonite protected the plasmid DNA from the acidic environment in the stomach and DNA-degrading enzymes in the intestine, and successfully delivered it into cells of the small intestine.

Dielectric study of heat-denatured ovalbumin in aqueous solution by time domain reflectometry method.

The dielectric behavior of native and heat-denatured ovalbumins (OVAs) from three avian species in aqueous solution was examined over a frequency range of 100 kHz to 20 GHz, using the time domain reflectometry (TDR) method. For the native OVA solutions, three kinds of relaxation processes were observed at around 10 MHz, 100 MHz, and 20 GHz, respectively; these could be assigned to the overall rotation of protein molecules, the reorientations of the bound water, and the free water molecules, respectively. For the heat-denatured samples, three relaxation processes were also observed. However, the relaxation process at approximately 100 MHz originated via a different mechanism other than the reorientation of bound water, namely, the micro-Brownian motion of peptide chains of heat-denatured protein. From the observed relaxation process at approximately 100 MHz, the relaxation strength of heat-denatured OVA solution for duck was higher than that of OVA solutions for hen and guinea fowl and showed the pH dependency from pH 7.0 to 8.0 for OVAs obtained from all three species. Furthermore, the results demonstrated that the relaxation strength was closely related to surface hydrophobicity of protein molecules and gel rheological properties. It was suggested that the difference in the surface hydrophobicity of protein influenced the dielectric behavior of water around denatured protein, whereas the dielectric behavior of denatured protein could be an indication of the gel rheological properties. Such studies can aid in the understanding of the different network structures of OVA gels from three avian species.

Effects of the counterion on dielectric spectroscopy of a montmorillonite suspension over the frequency range 10(5)-10(10) Hz.

Dielectric measurements were carried out on suspensions of montmorillonite clay exchanged with three different counterions: sodium, ammonium, and tetramethylammonium (TMA). Only two dielectric absorption peaks could be identified for the clay sample with the TMA counterion, whereas three peaks were found for the two inorganic counterions. The dielectric process observed at around 10 GHz is due to the orientation of bulk water molecules, judging from the relaxation time and relaxation strength. The relaxation strength of the process occurring at around 10 MHz was compared with the coefficient of adiabatic compressibility obtained from ultrasound velocity measurements. The increase in the relaxation strength with decreasing compressibility indicates that the process at around 10 MHz is caused by the orientation of bound water molecules on the clay samples. The relaxation strength of the process occurring at around 10 MHz for the TMA sample was remarkably small. Furthermore, the network structure of the bound water molecules can be characterized by a property peculiar to the TMA sample, taking into account the value of its Cole-Cole parameter. Results for the relaxation strength of the process occurring at around 100 kHz were compared with those for electrophoretic mobility. This comparison revealed that discrimination between bound ions and ions in the diffuse double layer is important, and both the relaxation and electrophoretic results could be satisfactorily explained by surface polarization of the clay.

Causative agent of vascular pain among photodegradation products of dacarbazine.

The photodegradation products of the anticancer drug, dacarbazine, cause adverse reactions including local venous pain when injected intravenously. In this study, we attempted to identify which of these products is responsible. We synthesized or purchased five photodegradation products of dacarbazine (dimethylamine, 5-diazoimidazole-4-carboxamide (Diazo-IC), 4-carbamoylimidazolium-5-olate, 5-carbamoyl-2-(4-carbamoylimidazol-5-ylazo)imidazolium-5-olate and 2-azahypoxanthine) and examined the pain reaction induced by their intraperitoneal administration in mice using an abdominal stretching or constriction assay. Only Diazo-IC clearly induced pain reaction in mice in a dose-dependent manner, the other products caused no pain reaction. The threshold concentration for pain reaction in mice was estimated to be about 0.1 mg mL-1. While diclofenac sodium significantly reduced acetic-acid-induced pain reaction in mice, it did not influence those induced by Diazo-IC. This result suggests that the mechanism of Diazo-IC-induced pain is different from that of acetic-acid-induced inflammatory pain. Dacarbazine itself produced marked relaxation of rat thoracic aorta strips in a concentration-dependent manner, but there was no difference between the activity of dacarbazine and its photo-exposed solution, so constriction or relaxation of blood vessels is unlikely to be a factor in the pain reaction. In conclusion, Diazo-IC generated by photodegradation of dacarbazine solution causes the side-effect of venous pain. Dacarbazine solution that has turned pink should not be used, because Diazo-IC is an intermediate in the formation of the reddish product, 5-carbamoyl-2-(4-carbamoylimidazol-5-ylazo)imidazolium-5-olate. Drip infusion preparations of dacarbazine should be shielded from light.

Mechanism of vinorelbine-induced radiosensitization of human small cell lung cancer cells.

Vinorelbine (Navelbine, KW-2307), a semisynthetic vinca alkaloid, is a potent inhibitor of mitotic microtubule polymerization. The aims of this study were to demonstrate vinorelbine-induced radiosensitization of human small cell lung cancer (SCLC) SBC-3 cells and to elucidate the mechanisms of radiosensitization. A clonogenic assay demonstrated that SBC-3 cells were sensitized to radiation by vinorelbine using different schedules combining exposure to both. The sensitizer enhancement ratios (SERs) at a cell survival level of 10% were 1.42+/-0.21 to 1.33+/-0.06, and 1.22+/-0.07 depending on schedule. Vinorelbine-induced radiosensitization did not depend on the schedule of the combined exposure. Flow cytometric analyses showed that the cells did not accumulate in the radiosensitive G(2)/M phase of the cell cycle after concurrent treatment with vinorelbine and radiation. The results of an alkaline filter elution assay demonstrated that in the presence of vinorelbine at 1 n M radiation-induced DNA strand breaks were not completely repaired at 24 h postradiation. We conclude that human SCLC SBC-3 cells are sensitized to radiation by vinorelbine and that a possible mechanisms of vinorelbine-induced radiosensitization may at least in part be associated with impairment of DNA repair following radiation-induced DNA damage.