[Computed tomography colonography for 5 cases of pneumatosis cystoides intestinalis].

Computed tomography colonography (CTC) was performed in 5 patients with pneumatosis cystoides intestinalis (PCI). The virtual colonoscopy view of CTC as well as total colonoscopy (TCS) findings showed polypoid lesions in the colon, and multiplanar reconstruction images of the colon revealed in the polypoid lesions of the colon. We confirmed the diagnosis of PCI in all cases. CTC also detected the PCI lesions in the subserosa of the colonic wall which were not detected by TCS. Accurate evaluation of the extent of PCI involvement was obtained by CT air-contrast enema images. CTC is useful for detection of PCI lesions, assessment of the exact site and final diagnosis for PCI.

Generation of carbanions through stibine-metal and bismuthine-metal exchange reactions and its applications to precision synthesis of ω-end-functionalized polymers.

Generation of carbanions from organostibines and organobismuthines through heteroatom-metal exchange reactions was examined from synthetic and mechanistic viewpoints. The exchange reaction proceeded spontaneously upon treatment with various organometallic reagents, such as alkyl lithiums, tetraalkyl zincates, and alkyl magnesium halides to afford the corresponding carbanions quantitatively. Due to the high reactivity of these heteroatom compounds, the exchange reactions took place exclusively even in the presence of various polar functional groups, which potentially react with organometallic species. The advantage of this method was exemplified by the end-group transformation of living polymers that bear these heteroatom species at the ω-polymer end, prepared by using organostibine and bismuthine-mediated living radical polymerizations. Various polymers that bear polar functional groups and acidic hydrogen-for example, poly(methyl methacrylate), poly(butyl acrylate), poly(N-isopropyl acrylamide), and poly(2-hydroxyethyl methacrylate)-could be used in the exchange reactions, and subsequent trapping with electrophiles afforded the corresponding polymers with controlled molecular weights, molecular weight distributions, and end-group functionalities. Competition experiments showed that organostibines and organobismuthines were among the most reactive heteroatom compounds towards organometallic reagents and that their high reactivity was responsible for the high chemoselectivity in the exchange reaction.

[A case of extrahepatic portal vein aneurysm with massive thrombosis].

A 59-year-old woman, who was given a diagnosis of portal vein aneurysm at another hospital 2 years previously, visited our institution complaining of abdominal pain in November 2005. Abdominal imaging including computed tomography and ultrasonography demonstrated that the portal vasculature had dilated to 5 cm in maximum dimension and its center was at the junction of the superior mesenteric vein and the splenic vein. Moreover, a large thrombus was seen in the portal vein, the superior mesenteric vein and the splenic vein. She was conservatively followed-up with warfarin. After 6 months, angiography revealed cavernous transformation around the portal vein was found with collateral flow toward the liver. At the time of writing the patient's condition is stable with neither extension of the thrombus nor constriction of the esophageal varices.

Dilution of boar ejaculates with BTS containing HEPES in place of bicarbonate immediately after ejaculation can reduce the increased inducibility of the acrosome reaction by treatment with calcium and calcium ionophore A23187, which is potentially associated with boar subfertility.

The present study investigated whether substitution of HEPES for bicarbonate in BTS (BTS-H) used to dilute boar ejaculates immediately after ejaculation could reduce the increased inducibility of the acrosome reaction by calcium and calcium ionophore A23187. When an ejaculate was split, diluted 5-fold with regular BTS (BTS-B) and BTS-H and stored at 17 C for 12 h or 60 h, the extender or storage time had no significant influence on sperm motility or viability measured by the eosin-nigrosin method. When spermatozoa diluted serially with BTS-B and stored (36 h) were stimulated with Ca2+ (3 mM) and A23187 (0.3 microM), the proportion of spermatozoa that underwent the acrosome reaction (% acrosome reactions) significantly increased as the magnifications of dilution increased (bicarbonate content almost unchanged by dilution). By contrast, the % acrosome reactions in spermatozoa similarly diluted and stored with BTS-H decreased with the increasing magnifications of dilution (bicarbonate decreased). Sperm motility immediately after the end of incubation without A23178 tended to be lower for BTS-H than BTS-B, and the ejaculates for BTS-H had a tendency to have a lower total protein in seminal plasma than those for BTS-B. These results implied that the samples for BTS-H could be used as a model for ejaculates possibly collected during summer and showing subfertility. When an ejaculate was split, diluted serially with BTS-B and BTS-H and stored, viability measured by staining with propidium iodide was extremely similar between the 2 extenders and among the different dilution magnifications, regardless of whether spermatozoa were washed (stored for 36-66 h) or not (stored for 66-72 h). These results suggest that boar ejaculate can be stored with BTS-H at least according to the results for sperm motility and viability and that hypersensitivity of spermatozoa to Ca2+ and A23187 potentially associated with boar subfertility could be lessened by diluting ejaculates with BTS-H.

Modification of the Nuss procedure for pectus excavatum to prevent cardiac perforation.

PURPOSE: In a few patients, cardiac perforation and aortic injury have occurred during the Nuss procedure for pectus excavatum. The article details a modification of this procedure that enables the prevention of fatal complications. METHODS: Our subjects were 22 males and 13 females with pectus excavatum who were aged 8.2 +/- 3.7 years. Their Haller's computed tomography index was 5.2 +/- 1.5. An introducer is inserted into the pleura between the sternum and thymus instead of the thoracic depression under right thoracoscopic guidance. After the introducer reaches the internal cranial position of the left nipple, the thoracoscope is shifted to the left thoracic cavity. The introducer is subsequently guided to the left highest intercostal space under left thoracoscopic guidance. RESULTS: A single bar was inserted in 34 patients; 2 bars were required in 1 patient. The operating time was 95 +/- 27 minutes and blood loss was 11 +/- 6 g. Cardiac perforation did not occur in any patient. CONCLUSIONS: Our modified technique has certain advantages: (1) the introducer does not rub against the pericardium and heart; (2) the tip of the introducer can be observed at all times with a thoracoscope; (3) the anterior mediastinum between the left and right thoracic cavities is very narrow at the cranial level; (4) the introducer can be accurately directed to the left highest intercostal space; and (5) hemostasis and no injury of the bilateral thoracic organs can be confirmed.

Catheter enterostomy and patch repair of the abdominal wall for gastroschisis with intestinal atresia: report of a case.

A male infant, weighing 2177 g, was born with the entire intestine protruding through a defect on the right side of the navel. Intestinal atresia, approximately 70 cm from the Treitz ligament, was also confirmed. Primary anastomosis and abdominal wall repair were impossible because of the intestinal dilation and thick peel, as well as the small abdominal cavity. Thus, we initially performed catheter enterostomy with a 14-F balloon catheter and patch repair of the abdominal wall, to enable the baby to be fed. Secondary anastomosis and abdominal wall repair was safely performed when the baby was 106 days old. The combination of catheter enterostomy and patch repair of the abdominal wall does not require dissection of the intestine and it can be safely performed in low-birth-weight babies. It also enables feeding and weight gain, and the overlying skin prevents contamination of the artificial sheet. We recommend this combination for neonates with both gastroschisis and intestinal atresia.

Clinical and pathological features of ascending testis.

BACKGROUND: The clinical features and principles of surgery of the Ascending Testis (AT), in which the testis ascends from the scrotum with age, are controversial. We selected AT that met the treatment guidelines and examined the clinical features and principles of surgery. METHODS: We retrospectively reviewed the medical charts of 12 AT and 530 Congenital Undescended Testis (CUDT) patients to investigate the statistics of AT among all CUDT, the side of the maldescent, the associated disorders, and the clinical course. The patients were compared in terms of testicular volume (TV), mean tubular diameter (MTD), and testicular fertility index (TFI) between the AT group and the CUDT group. RESULTS: AT was observed in 2.2% of all CUDT patients: 10 had left AT and 2 had bilateral AT. Among the 12 AT patients, 8 patients had associated disorders. The TV, MTD, and TFI of 7 AT and 7 CUDT were 0.74 +/- 0.20 and 0.77 +/- 0.59 cm3, 38.7 +/- 3.7 and 35.9 +/- 9.1 microm, and 0.19 +/- 0.07 and 0.11 +/- 0.11, respectively. CONCLUSIONS: In order to examine the clinical features of AT, it is essential to strictly rule out CUDT and retractile testis. In our study, the clinical features are that AT is a rare disorder, occurs more frequently on the left side, and many patients with AT have associated disorders. Since AT causes histological damage equivalent to that caused by CUDT, we should perform orchidopexy for patients with AT immediately after diagnosis.

Esophageal atresia with tracheoesophageal fistula in both members of monozygotic twins.

A 29-year-old healthy woman bore monozygotic male twins at 37 weeks of gestation by cesarean section. They weighed 2,350 and 2,140 g, respectively. Twin B was found to have a ventricular septal defect. They were diagnosed with esophageal atresia (EA) with tracheoesophageal fistula and underwent primary end-to-end esophageal anastomosis at the age of 1 day. Their postoperative courses were uneventful. Although the incidence of EA is higher in twins than in singletons, usually, EA affects only one of twins. There have been only 20 pairs of twins concordant for the EA anomaly. There is no distinct difference between sporadic EA and EA in both twins (EABT) with regard to sexuality, classification, and incidence of associated anomalies. The zygosity of EABT consisted of 15 monozygosities (83.3%) and 3 dizygosities (16.7%). An overwhelmingly higher incidence of monozygosity than that of dizygosity in EABT suggests that genetic factors must play a considerable role in the embryology in EABT cases.

Surveillance of bacteriological examinations at hospitalization in a pediatric surgical ward.

PURPOSE: Bacteriological examinations at hospitalization were monitored to identify carriers of pathogenic bacteria and prevent the outbreak of nosocomial and postoperative infections. METHODS: In 557 patients, bacteriological examinations were performed within 48 hours after hospitalization. All people were instructed to wash their hands before and after treating carriers of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), and/or Pseudomonas aeruginosa (PA). The disposal of stool and urine of carriers was segregated instead of administration of sensitive antibiotics. RESULTS: The 1176 samples comprised 557 throat swabs, 532 stool samples, and 87 other samples. At hospitalization, 9.2% of the patients were carriers of MRSA; 22.3% of the patients were carriers of MRSA, MRSE, PA, and/or other pathogenic bacteria. This percentage increased to 29.3% in 352 patients with a history of hospitalization, and 35.2% in 244 patients who were hospitalized within 1 year after previous hospitalization. Nosocomial and postoperative infections did not occur during the study period. CONCLUSION: Many patients were detected as carriers of pathogenic bacteria at hospitalization. A history of hospitalization was found to be a risk factor for carrying pathogenic bacteria; hospitalization within 1 year after previous hospitalization was a high-risk factor.

Anopenile urethral fistula.

A newborn male weighing 3,650 g was born without an anal opening and a perineal fistula. However, an invertography showed rectal gas below the ischium. At the age of 1 day, the patient underwent colostomy. Based on colonourethrography that revealed a fistula between the rectum and the spongy urethra, the patient was diagnosed with an anopenile urethral fistula (APUF). At the age of 7 months, the patient underwent anterior sagittal anorectoplasty (ASARP). The sphincter muscles were divided at the midline. After ligating the fistula, the rectum was pulled through to the anal dimple. At the age of 11 months, a colostomy closure was performed. Consequently, the fistula in the corpus spongiosum penis was not removed. It has been 14 years since the operation was performed, and the patient has had no problems with regard to urination and defecation. According to the embryological studies of the anorectum, APUF could occur due to the following reasons: incomplete descent of the urorectal septum, failed disappearance of the dorsal cloacal membrane, and excessive elongation of the urorectal septum in the phallus. The ASARP provides a superior operative field to identify the fistula and the sphincter muscles. Complete removal of the fistula in the corpus spongiosum penis is unnecessary.

Seasonal changes in semen characteristics, composition of seminal plasma and frequency of acrosome reaction induced by calcium and calcium ionophore A23187 in Large White boars.

This study attempted to explain the mechanisms regulating boar fertility by examining seasonal changes in semen characteristics, the composition of seminal plasma and responsiveness of sperm acrosomes to Ca(2+) and the Ca(2+) ionophore A23187 (Ca(2+)/A23187). Sperm-rich and sperm-poor fractions were separately collected from 3 mature fertile Large White boars once a month over a one-year period. During the period of study, ambient temperature and relative humidity were recorded for within the stall in which the boars were kept and the semen characteristics, composition of the seminal plasma of sperm-rich fractions, and occurrence of the acrosome reaction in response to Ca(2+) (3 mM)/A23187 (0.3 microM) were examined. The highest mean maximum and minimum ambient temperatures were recorded in August-September, whereas the lowest mean maximum and minimum ambient temperatures were recorded in December and January, respectively. There was a moderate peak in relative humidity from July to October. The lowest percentages of motile spermatozoa and of spermatozoa with intact acrosomes and highest percentage of spermatozoa with abnormal morphology and strongest agglutination were seen in August-September. The total protein and albumin concentrations were lowest in August-September. Testosterone levels increased gradually as day length decreased after the summer solstice (June) and peaked in October-November. The percentage of acrosome reactions in response to Ca(2+)/A23187 was highest with the quickest response in August-September, as shown by the shortest time required for 50% of relative acrosome reactions. The farrowing rates were lowest in these same 2 months. These results suggest that seasonal infertility in Large White boars may be due, at least in part, to a combination of low motility, abnormal morphology including acrosomal abnormality, and early occurrence of the acrosome reaction in response to stimulus, possibly resulting from a decrease in acrosomal stabilizing proteins in the seminal plasma during summer. These changes may be modulated by heat/humidity stress and/or photoperiod-regulated testosterone.

Intracisternal injection of orexin-A prevents ethanol-induced gastric mucosal damage in rats.

BACKGROUND: Accumulating evidence indicates that orexin-A in the brain stimulates vagal flow projecting to the stomach. Since the vagal system plays an important role in gastric mucosal integrity, we hypothesized that orexin-A in the brain might have a gastroprotective action. METHODS: We examined the effect of centrally administered orexin-A on the development of gastric mucosal damage evoked by ethanol and its possible mechanism of action in rats. RESULTS: Intracisternal but not intraperitoneal injection of orexin-A significantly inhibited the severity of gastric mucosal damage by 70% ethanol in a dose-dependent manner, suggesting that orexin-A acts in the brain to prevent ethanol-induced gastric mucosal damage. The antiulcer action was observed in rats administered with orexin-A centrally but not orexin-B, indicating that the action is mediated through orexin 1 receptors. The gastroprotective action of centrally administered orexin-A was blocked by pretreatment with atropine, Nomega-nitro-L-arginine methylester, or indomethacin. CONCLUSIONS: These results suggest that orexin-A acts on orexin 1 receptors in the brain to exert a gastroprotective action against ethanol. The vagal muscarinic system, nitric oxide, and prostaglandins may mediate the cytoprotective action of centrally administered orexin-A.

A selective orexin-1 receptor antagonist, SB334867, blocks 2-DG-induced gastric acid secretion in rats.

We have previously demonstrated that intracisternal orexin-A potently stimulated gastric acid secretion through the vagus nerve. Considering its stimulatory action on feeding, we hypothesized that orexin-A is a candidate mediator of cephalic phase gastric secretion. It has also been suggested that the stimulation of acid by central orexin-A may be mediated by orexin 1 receptor (OX1R) in the brain. In the present study, we tried to clarify whether endogenously released orexin-A in the brain indeed plays a physiological role in gastric secretion. To address the question, the effects of OX1R antagonist on gastric acid secretion was examined in rats. Intraperitoneal administration of SB334867, a specific OX1R antagonist, by itself did not change gastric acid secretion in pylorus-ligated conscious rats. Pretreatment with SB334867 in a dose of 10 mg/kg completely blocked the stimulated acid output by intracisternal orexin-A but not thyrotropin-releasing hormone, suggesting that SB334867 specifically blocked the action of orexin-A in the brain. 2-Deoxy-D-glucose (2-DG)-induced stimulation of gastric acid output was significantly blocked by pretreatment with intraperitoneal administration of SB334867. These results suggest that endogenously released orexin-A in the brain plays a vital role in central regulation of gastric secretion. Since 2-DG induces central glucoprivation as a hunger state, the present study furthermore supports the speculation that orexin-A may be an important molecule that triggers the cephalic phase gastric acid secretion.

Indications for surgical repair of funnel chest based on indices of chest wall deformity and psychological state.

PURPOSE: We examined the surgical indications for funnel chest, taking psychological factors into consideration. METHODS: We assessed 36 young people with funnel chest who were seen as outpatients, including 31 boys and 5 girls aged from 1 to 22 years old. Respondents were asked whether they suffered psychological distress, and if they wanted surgery. The severity of the deformity was evaluated using the Vertebral Index (VI) and the Frontosagittal Index (FSI) calculated from chest roentgenograms. RESULTS: The VI in 11 patients without distress (23.7 +/- 4.1) was lower than that in 25 patients with distress (32.8 +/- 8.2), and the FSI in the patients without distress (33.5 +/- 5.3) was higher than that in the patients with distress (23.6 +/- 8.6). The VI in 19 patients who did not want surgery (26.9 +/- 7.9) was lower than that in 17 patients who did (33.5 +/- 7.5), and the FSI in the patients who did not want surgery (30.4 +/- 8.1) was higher than that in the patients who did (22.4 +/- 8.1). The distressed patients suffered many psychological problems, such as being the object of bullying. CONCLUSION: The severity of the deformity affected the patient's psychological state. We consider that a VI >28 or an FSI <28 are indications for surgery, based on the mean VI + SD and the mean FSI-SD of patients not suffering distress.

Comparison of the Nuss procedure for pectus excavatum by age and uncommon complications.

BACKGROUND: We summarized our experience of the Nuss procedure for pectus excavatum with comparison by age and uncommon complications. METHODS: Twenty-three patients underwent the Nuss procedure. Their age ranged from 3 to 19 years old. The outcome was compared between two groups divided by age: teenagers (> or = 13 yrs old, n = 5, Group 1) and younger patients (n = 18, Group 2). RESULTS: Cosmetic results were significantly better, and the operating time and postoperative hospital stay in Group 2 were significantly shorter than in Group 1. Complications were more frequently seen in Group 1 than in Group 2. In all three younger patients whose bars were removed after 2 years, the ribs holding the bar were deformed. Uncommon complications occurred in two cases. In one case, pneumothorax occurred due to laceration by a fragment of wire after 12 months, and the fragment fell into the thoracic cavity. In another case, pneumothorax occurred due to injury by the port of a thin thoracoscope. CONCLUSION: The teenaged patients had more complications and poorer cosmetic results. Therefore, this operation should be performed before the teenage years. In younger patients with rapid growth, the bar should be removed less than 2 years to prevent restriction of costal growth.

Groove pancreatitis: report of a case and review of the clinical and radiologic features of groove pancreatitis reported in Japan.

We report a case of groove pancreatitis in which a hypoechoic mass between the duodenum and pancreas head was clearly imaged, and narrowing of the supra-ampullary area of the duodenum and bile duct stenosis were also found. The diagnosis was confirmed by surgery. Microscopic examination showed extensive scarring between the duodenum and pancreas head. Protein plugs were found in Santorini's duct. We consider that the disturbance of the pancreatic juice outflow in Santorini's duct is one of the important pathogenic factors in the development of groove pancreatitis. Therefore, we emphasize the finding of Santorini's duct in the differential diagnosis of groove pancreatitis.

[Microwave coagulation therapy for unresectable colorectal metastatic liver tumor].

INTRODUCTION: We evaluate the utility of microwave coagulation therapy (MCT) for the patients with unresectable liver metastasis from colorectal cancers. METHODS: Forty-four patients unresectable synchronous colorectal hepatic metastasis between January 1, 1989 and December 31, 2000, were enrolled in the present study. The patients courses were followed until March, 2002. To evaluate the efficacy of MCT for unresectable liver metastasis from colorectal cancers, a retrospective comparative study was done between a MCT with CT (hepatic arterial trans-infusion chemotherapy and/or systemic chemotherapy) group and a CT group. The background factors were examined included the maximum tumor diameter, the number of liver metastasis and disease of other metastatic sites, which influenced the outcome. RESULTS AND CONCLUSION: The survival curves of the patients with unresectable synchronous colorectal hepatic metastasis undergoing MCT with CT and CT alone were significantly different (p = 0.03). No significant differences were found in the background factors that had a prognostic influence. It is confirmed that using MCT can prolong the survival rate for the patients with unresectable synchronous colorectal hepatic metastasis.

Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy.

OBJECTIVE: The aim of the present study was to assess the presence of duodenal erosion and its clinical characteristics on endoscopy in patients with portal hypertension who had undergone endoscopic injection sclerotherapy and/or endoscopic variceal ligation for esophagogastric varices. METHODS: The subjects were 440 patients with portal hypertension, 450 with chronic hepatitis as a related control group, and 450 who underwent upper endoscopic examination as part of their routine physical examination as the controls. The underlying hepatic disease, hepatic function, and endoscopic findings of duodenal erosion among the patients with portal hypertension were studied. RESULTS: Duodenal erosion was found in 68 patients with portal hypertension (68 of 440, 15.5%), four patients with chronic hepatitis (four of 450, 0.9%), and two controls (two of 450, 0.4%). The incidence of duodenal erosion among the patients with portal hypertension was significantly higher than that in the other two groups (p < 0.01, p < 0.01, respectively). The lesions commonly observed in duodenitis are speckle erosions mainly located in the duodenal bulb. However, the most frequently seen form of duodenal erosion among the patients with portal hypertension extended from the superior portion to the descending portion, and tended to show a circular alignment along the Kerckring's folds. The patients with portal hypertension with reduced hepatic reserve capacity had more severe duodenal erosion. Endoscopic ultrasonography revealed thickening of the duodenal wall and proliferation of vascular structures within and around the wall. The histological findings of the duodenal erosion included edema and vascular dilation in the mucosal and submucosal layers. CONCLUSIONS: The location of duodenal erosion in patients with portal hypertension differs from that in patients with ordinary duodenitis. Duodenal erosion in patients with portal hypertension is considered to be one of the lesions of portal hypertensive duodenopathy.