CHARACTERISATION OF RADIOACTIVE CAESIUM IN SEDIMENTS AT THE NOGAWA RIVER, JAPAN.

The TEPCO Fukushima Daiichi Nuclear Power Plant accident that occurred in March 2011 resulted in the release of radioactive caesium into the environment. The radioactive caesium has been detected in the Tama River watershed. Previous investigations have shown that the concentration of radioactive caesium in sediment was relatively high in the Nogawa River. In this study, the relationship between the concentration of radioactive caesium in the sediment and the sediment characteristics was investigated. We found that 137Cs concentration in the tributary sediment has difficulty migrating downstream, while exhibiting a strong correlation with the amount of organic matter and a correlation with the clay, silt layer. Based on the results, we inferred that 137Cs is deposited together with the organic matter and clay, silt layer in the sediment and migrates at a slower pace than that in the mainstem.

FIXED-POINT OBSERVATION AND CHARACTERIZATION OF RADIOACTIVE CS IN SOIL COLLECTED AT KAWASAKI, JAPAN.

Radioactive Cs derived from the Fukushima Daiichi Nuclear Power Plant accident was detected in soils sampled at Kawasaki, Japan. Radioactive Cs adsorbed on soil is hard to be removed. Fixed-point observation of radioactive Cs concentration was performed on two observation sites of Meiji University. The soil samples were also analyzed for the distribution of radioactive Cs concentration and chemical form. 10 years after the accident, the activity concentration of radioactive Cs in soil samples at the Ikuta Campus of Meiji University ranged from 127 to 448 Bq kg-1. The sequential extraction method results indicated that most radioactive Cs in the surface soil exists in a poorly soluble form.

Mesocolic hernia after laparoscopic transverse colectomy: A case report.

INTRODUCTION: Internal hernias are rare after laparoscopic colorectal resections. We report a patient with an internal hernia through a defect in the transverse mesocolon following laparoscopic resection. PRESENTATION OF CASE: A 52-year-old male underwent laparoscopic colectomy for transverse colon cancer and had an unremarkable postoperative course. Thirty days postoperatively, he presented to the emergency room with sudden onset abdominal pain and vomiting. Enhanced abdominal computed tomography scan showed strangulated small intestine in the left upper abdomen. An internal hernia through the mesenteric defect created during the recent colon resection was suspected, and emergency laparotomy was performed. One hundred thirty cm of small intestine was found herniated through a mesenteric defect. After repositioning the ischemic-appearing intestine, a 5 cm defect in the transverse mesocolon was found which had not been closed during the previous laparoscopic operation. No intestinal resection was needed, and the mesenteric defect closed with non-absorbable sutures. The post-operative course was unremarkable except for paralytic ileus, which resolved without further intervention. DISCUSSION: The incidence of internal hernia through a mesenteric defect after laparoscopic colorectal resection is quite low. Therefore, routine closure of the mesenteric defect after laparoscopic colorectal resection is not required. However, a left sided defect in the transverse mesocolon might be at higher risk of causing an internal hernia on anatomic grounds. CONCLUSION: We believe that mesenteric defects should be closed after laparoscopic resection of the left side of transverse colon, regardless of their size.

[Assessment of Functional Results after Sphincter-Preserving Surgery in Elderly Patients with Low Rectal Cancer].

The aim of this study was to evaluate postoperative dysfunction and potential problems after a sphincter-preserving operation in elderly patients with low rectal cancer. METHODS: Between 2000 and 2012, 307 consecutive patients with low rectal cancer underwent curative sphincter-preserving surgery. We evaluated postoperative anal and urinary dysfunction in 190 patients who responded to a questionnaire by mail. RESULTS: After a median follow-up of 5.7 years, there was no significant difference between the elderly and a younger group in the Wexner incontinence score. Poor anal function assessed by modified FIQL was significantly associated with the elderly. Poor urinary function assessed by the IPSS score was significantly associated with the elderly, diabetes mellitus, and autonomic nerve preservation(AN2-3). CONCLUSION: From the viewpoint of urinary function, sphincter-preserving surgery with all autonomicnerve preservation(AN4)should be considered for elderly people and patients with diabetes.

[Regrowth of Isolated Local Residual Tumor Effectively Treated with Chemoradiotherapy More Than Five Years after a Resection for Pancreatic Cancer with an Involvement of the Portal Vein].

A 55-year-old man who presented with abdominal pain was diagnosed with pancreatic head cancer involving the portal vein. He underwent pylorus-preserving pancreaticoduodenectomy without a resection of the portalvein, resulting in a macroscopic residualtumor, because radicalresection was impossible owing to the severe localinvasion. Postoperative chemotherapy( GEM plus S-1)was administered. The tumor size decreased and CA19-9 values normalized. Five years after the resection, chemotherapy was stopped. The regrowth of an isolated local residual tumor without a distant metastasis was diagnosed 65 months after the resection. He underwent chemoradiotherapy(CRT)with S-1. The size of the tumor remained stable, but FDG-PET demonstrated a disappearance of high FDG uptake in the tumor and CA19-9 values normalized. We reported a case in which CRT was an effective treatment for the regrowth of localresidualtumor after resection for pancreatic cancer.

Indication of endoscopic retrograde cholangiography by noninvasive predictive factors of common bile duct stones before laparoscopic cholecystectomy: a prospective clinical study.

PURPOSE: To evaluate the reliability of a screening method in patients with common bile duct (CBD) stones before laparoscopic cholecystectomy (LC) based on predictive factors, and to determine the cases for which preoperative therapeutic endoscopic retrograde cholangiography (ERC) is indicated. MATERIALS AND METHODS: Alkaline phosphatase, total bilirubin, amylase, and dilation of CBD results were defined as predictive factors for CBD stones. In cases in which all these 4 factors were negative, preoperative ERC was omitted, and in cases in which 1 of the 4 factors was positive, ERC was performed before LC. RESULTS: A total of 323 patients (83.7%) in whom all 4 factors were negative, ERC was omitted. In all the 63 patients (16.3%) in whom 1 of the 4 factors was positive, ERC was performed. In 52 (82.5%) of them, CBD stones were present and in 43 of them, LC was performed after endoscopic choledocholithotomy. CONCLUSIONS: For cases in which any 1 of the 4 factors was positive before LC, it was strongly recommended to perform preoperative ERC.

[Efficacy of hepatic arterial infusion chemotherapy with cisplatin for advanced hepatocellular carcinoma].

BACKGROUND: Transcatheter arterial chemoembolization (TACE) was performed as the initial therapy for advanced hepatocellular carcinoma (HCC). However, no effective chemotherapy has been established for patients who did not respond to TACE, and for those the therapy was not suitable. Since 2004, transcatheter arterial infusion (TAI) chemotherapy using fine-powder cisplatin has been applied at our department to such cases mentioned before. This report described the therapeutic results of TAI therapy and presented a case of HCC accompanied by portal vein tumor thrombus (PVTT) for which the therapy was effective. PATIENTS AND METHODS: TAI was performed using cisplatin in 16 patients with inoperable advanced HCC between 2004 and 2010. Cisplatin was infused into the proper hepatic artery at a dose of 65 mg/m2 for 30 minutes. RESULTS: TAI was performed in each patient 1.8 times on average, ranging from 1 to 8 times. Therapeutic Effect 4 (TE4) was obtained in 1 case, TE3 in 2, TE2 in 1, and TE1 in 11 cases. The only severe adverse event rated as grade 3 or above during the study were nausea and anorexia reported in 6.3% of the patients, and adverse events rated as less than grade 2 were increased serum hepato-biliary enzyme levels in 68.8%, nausea in 68.8% of the patients. The overall 1-year survival rate was 31.2%, and the 50% survival period was 314 days. CONCLUSION: As a treatment option following the initial TACE therapy for advanced HCC, TAI using cisplatin can improve the prognosis of HCC.

Carcinoma of the ampulla of vater arising from the peribiliary gland.

The present paper reported a case of a carcinoma that probably developed from the peribiliary gland within the ampulla of Vater based on the histopathological findings of the resected specimens. A 49-year-old female became aware of epigastralgia and was diagnosis of stenosis of duodenal 2nd portion. There were no malignant findings on gastrointestinal endoscopy and computed thomography. Endoscopic retrograde cholangiopancreatography revealed no tumor in the main pancreatic duct or the common bile duct or ampulla of Vater. Pylorus preserving panctreaticoduodenectomy was performed with a diagnosis of duodenal stenosis of unknown cause. The histopathological findings revealed that a moderately to poorly differentiated adenocarcinoma originating near the peribiliary gland in the ampulla of Vater was extensively distributed in the submucosal layer of the duodenum. Based on these findings, a diagnosis of a carcinoma of the ampulla of Vater arising from the peribiliary gland was most likely suspected. Judging from the generally known development and extension of carcinoma of the ampulla of Vater, the current case appeared to be a very rare one.

[Two cases of advanced hepatocellular carcinoma with portal vein tumor thrombus responding to transcatheter arterial infusion chemotherapy using cisplatin].

We report two cases of advanced hepatocellular carcinoma( HCC) with a portal vein tumor thrombus (PVTT) responding to transcatheter arterial infusion chemotherapy (TAI) using cisplatin (CDDP). Case 1: A 65-year-old male patient was diagnosed with unresectable multiple HCCs. After 5 courses of transcatheter arterial chemoembolization (TACE), the tumor became markedly enlarged, and a PVTT (Vp2) and lymph node metastasis were noted. TAI was conducted as the second- line chemotherapy, and the liver tumor, PVTT, and lymph node metastasis shrank. The clinical response was rated as a partial response (PR). Case 2: A 72-year-old female patient was diagnosed with single HCC. After a course of TACE, the tumor became markedly enlarged and was accompanied by a PVTT (Vp4). TAI was performed as the second-line chemotherapy, and the liver tumor and PVTT significantly shrank. The clinical response was also rated as a PR. TAI using CDDP as the second-line chemotherapy for advanced HCC is a promising treatment likely to contribute to the improvement of the patient's prognosis.

[Chemotherapy with gemcitabine after non-curative resection of bile duct cancer--a case report].

Non-curative resection for cholangiocarcinoma usually leads to a poor prognosis. We present a case successfully treated with gemcitabine for residual tumor after extra hepatic bile duct resection with positive surgical margin. The patient was a 77-year-old male who was diagnosed as having a common bile duct cancer. Extra hepatic bile duct resection was performed, but intraoperative pathology diagnosed the surgical margin of duodenal-side bile duct was positive for cancer. Although additional resection of bile duct was done, pathological diagnosis resulted in positive margin again. We had to avoid pancreatoduodenectomy in light of the patient's wishes, so a curative resection could not be carried out. Adjuvant chemotherapy with gemcitabine(800 mg/m2 on days 1, 8 and 15 every 4 weeks)was started at the seventh postoperative day. A residual lesion was shown in the pancreas head by abdominal CT after 2 courses of chemotherapy. Follow-up CT was performed every 6 months, and the lesion gradually seemed to become unclear. Finally, CT showed disappearance of the residual lesion 28 months after surgery. The chemotherapy has been continued up to the present(3 years and 5 months after surgery). No evidence of recurrence nor adverse events of WHO grade 2 or more has been observed.

[A case of drug-induced interstitial pneumonitis after adjuvant chemotherapy with gemcitabine for pancreatic cancer].

We present a case of interstitial pneumonitis induced by gemcitabine. The patient was a 48-year-old male who underwent pancreaticoduodenectomy with portal vein resection for ductal adenocarcinoma of the pancreas head. Twenty-two days after operation, adjuvant chemotherapy with gemcitabine(1,000 mg/m(2) on days 1, 8 and 15 every 4 weeks)was started. During three courses of chemotherapy, no adverse event of WHO grade 2 or more was observed. Seven days after the last infusion, fever and consciousness disorder emerged without respiratory symptoms. Arterial blood gas analysis revealed severe hypoxemia. Chest X-ray and CT showed diffuse bilateral interstitial infiltrates. Oxygenation and respiratory support were immediately given, and steroid pulse therapy with 1,000 mg/day of methylprednisolone was started. His symptoms and radiolographical findings were dramatically improved. The patient could be discharged on the 14th day after admission. Acute pulmonary toxicity induced by gemcitabine is rare, but could lead to severe complications. The review of reported cases showed the effectiveness of corticosteroid therapy for pulmonary toxicity due to the agent.

Preoperative assessment for feasibility of laparoscopic cholecystectomy using magnetic resonance cholangiography.

BACKGROUND/AIMS: We present the results of classification of magnetic resonance cholangiography (MRC) focusing upon visualization of cystic duct for preoperative laparoscopic cholecystectomy (LC), along with assessments of a possible correlation between MRC classification and feasibility of LC. METHODOLOGY: The study included a total of 663 patients who were diagnosed as cholelithiasis. MRC were classified into four types: Type A; entire biliary tract was visualized (+), Type B; cystic duct (+) but gallbladder was not(-), Type C; gallbladder (+), cystic duct (-), and Type D; gallbladder (-), cystic duct (-). The feasibility of LC was assessed using the following two variables: 1) percentages of cases in which LC was changed to open cholecystectomy (OC) and 2) operating time. The results were compared in respect of the relationship with the MRC classification. RESULTS: MRC were classified as follows: Type A (58.4%), Type B (15.2%), Type C (19.3%) and Type D (7.1%). A total of 124 patients (18.7%) had chronic cholecystitis, and a strong correlation with MRC type was noted (p<0.0001). In 46 patients (7.5%), the surgical procedure was changed from LC to OC. The percentages of cases in which LC was changed to OC was significantly higher for Type C and Type D (p<0.0001), so these two groups demonstrated prolonged operating time. CONCLUSIONS: Our MRC classification based on the visualization of cystic duct can reflect the feasibility of LC, and LC may be less feasible tin Type C, and in particular Type D patients.

[Transradial approach for transcatheter arterial chemoembolization in patients with unresectable and recurrent hepatocellular carcinoma--a comparison with a conventional transfemoral approach].

We evaluated a clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TAE) in patients with unresectable and recurrent hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group; n=385, 1999.7-2007.3, femoral group; n=150, 1997.4-1999.6) of cases were retrospectively compared with regard to the successful rate of angiography, TAE, interventional time, Lipiodol retention pattern and complications. Hepatic angiography and TAE were completed in 379 (98.4%) of 385 cases in the radial group. There was no inter-group difference of interventional time. Minor complications (dull pain or numbness of puncture site) occurred in 29 (7.6%) patients in the radial group. Transradial approach has some advantages as follows: (1) No time will be required to stop breeding after removal of sheath. (2) The patient may freely walk after the examination. TAE by our new transradial approach for HCC was found to have a therapeutic efficacy with lower complications comparable to that of conventional transfemoral approach.

Pylorus-preserving pancreaticoduodenectomy without homologous blood transfusion in a Jehovah's witness with pancreatic cancer: report of a case.

A case of successfully treated pancreatic cancer without homologous blood transfusion in a Jehovah's witness is reported. The patient was a 60-year-old Japanese man and he was diagnosed with pancreatic cancer. Based on the patient's informed consent, human recombinant erythropoietin (12000 IU/day), saccharated ferric oxide (60 mg/day), and 25% human serum albumin (100 mL/day) were administrated for 7 consecutive days prior to the operation. As a result, the hemoglobin level increased by 1.6 g/dL during the week, pylorus-preserving pancreaticoduodenectomy was performed on June 5, 1998. We used a technique of transfusing diluted autologous blood, hypervolemic hemodilution, and a cell-saver device for autologous transfusion during the operation. The operation took 10 hours and 35 minutes, blood loss was 600 mL, and the hemoglobin level at the end of surgery was 12.0 g/dL. He had an uneventful postoperative course, and was discharged on the 31st postoperative day. Although there have been numerous reports on surgery without homologous blood transfusion in Jehovah's witnesses, many of the cases of major surgery have involved cardiovascular procedures. However, major digestive surgery may be feasible in more Jehovah's witnesses if adequate alternative treatments and strict nutritional management are carefully implemented, as in our case.